Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 1 of 54
B22A (Official Form 22A) (Chapter 7) (12/08) 

In re ______________________________

Debtor(s) 

Case Number: __________________

(If known) 

According to the information required to be entered on this statement 

(check one box as directed in Part I, III, or VI of this statement): 

 The presumption arises. 

 The presumption does not arise. 

 The presumption is temporarily inapplicable.

CHAPTER 7 STATEMENT OF CURRENT MONTHLY INCOME 

AND MEANS-TEST CALCULATION 

In addition to Schedules I and J, this statement must be completed by every individual chapter 7 debtor, whether or not filing 

jointly. Unless the exclusion in Line 1C applies, joint debtors may complete a single statement. If the exclusion in Line 1C 

applies, each joint filer must complete a separate statement.

Part I. MILITARY AND NON-CONSUMER DEBTORS

1A

Disabled Veterans. If you are a disabled veteran described in the Declaration in this Part IA, (1) check the box at the 

beginning of the Declaration, (2) check the box for “The presumption does not arise” at the top of this statement, and (3) 

complete the verification in Part VIII. Do not complete any of the remaining parts of this statement. 

 Declaration of Disabled Veteran. By checking this box, I declare under penalty of perjury that I am a disabled 

veteran (as defined in 38 U.S.C. § 3741(1)) whose indebtedness occurred primarily during a period in which I was on 

active duty (as defined in 10 U.S.C. § 101(d)(1)) or while I was performing a homeland defense activity (as defined in 32 

U.S.C. §901(1)). 

1B 

Non-consumer Debtors. If your debts are not primarily consumer debts, check the box below and complete the 

verification in Part VIII. Do not complete any of the remaining parts of this statement. 

 Declaration of non-consumer debts. By checking this box, I declare that my debts are not primarily consumer debts.

1C

Reservists and National Guard Members; active duty or homeland defense activity. Members of a reserve component 

of the Armed Forces and members of the National Guard who were called to active duty (as defined in 10 U.S.C. 

§ 101(d)(1)) after September 11, 2001, for a period of at least 90 days, or who have performed homeland defense activity 

(as defined in 32 U.S.C. § 901(1)) for a period of at least 90 days, are excluded from all forms of means testing during the 

time of active duty or homeland defense activity and for 540 days thereafter (the “exclusion period”). If you qualify for 

this temporary exclusion, (1) check the appropriate boxes and complete any required information in the Declaration of 

Reservists and National Guard Members below, (2) check the box for “The presumption is temporarily inapplicable” at the 

top of this statement, and (3) complete the verification in Part VIII. During your exclusion period you are not required 

to complete the balance of this form, but you must complete the form no later than 14 days after the date on which 

your exclusion period ends, unless the time for filing a motion raising the means test presumption expires in your 

case before your exclusion period ends.

 

 Declaration of Reservists and National Guard Members. By checking this box and making the appropriate entries 

below, I declare that I am eligible for a temporary exclusion from means testing because, as a member of a reserve 

component of the Armed Forces or the National Guard 

 a. I was called to active duty after September 11, 2001, for a period of at least 90 days and 

I remain on active duty /or/ 

I was released from active duty on ________________, which is less than 540 days before 

this bankruptcy case was filed; 

 OR 

 b. I am performing homeland defense activity for a period of at least 90 days /or/ 

 I performed homeland defense activity for a period of at least 90 days, terminating on 

 _______________, which is less than 540 days before this bankruptcy case was filed. 

Favela, Ruby

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 2 of 54
B22A (Official Form 22A) (Chapter 7) (12/08) 2

Part II. CALCULATION OF MONTHLY INCOME FOR § 707(b)(7) EXCLUSION 

2

Marital/filing status. Check the box that applies and complete the balance of this part of this statement as directed. 

a. Unmarried. Complete only Column A (“Debtor’s Income”) for Lines 3-11. 

b. Married, not filing jointly, with declaration of separate households. By checking this box, debtor declares under 

penalty of perjury: “My spouse and I are legally separated under applicable non-bankruptcy law or my spouse and I 

are living apart other than for the purpose of evading the requirements of § 707(b)(2)(A) of the Bankruptcy Code.” 

Complete only Column A (“Debtor’s Income”) for Lines 3-11. 

c. Married, not filing jointly, without the declaration of separate households set out in Line 2.b above. Complete both 

Column A (“Debtor’s Income”) and Column B (“Spouse’s Income”) for Lines 3-11.

d. Married, filing jointly. Complete both Column A (“Debtor’s Income”) and Column B (“Spouse’s Income”) for 

Lines 3-11.

All figures must reflect average monthly income received from all sources, derived during 

the six calendar months prior to filing the bankruptcy case, ending on the last day of the 

month before the filing. If the amount of monthly income varied during the six months, you 

must divide the six-month total by six, and enter the result on the appropriate line.

Column A 

Debtor’s 

Income

Column B 

Spouse’s 

Income

3 Gross wages, salary, tips, bonuses, overtime, commissions. $ $

4

Income from the operation of a business, profession or farm. Subtract Line b from Line a 

and enter the difference in the appropriate column(s) of Line 4. If you operate more than one 

business, profession or farm, enter aggregate numbers and provide details on an attachment. 

Do not enter a number less than zero. Do not include any part of the business expenses 

entered on Line b as a deduction in Part V.

a. Gross receipts $

b. Ordinary and necessary business expenses $

c. Business income Subtract Line b from Line a

$ $

5

Rent and other real property income. Subtract Line b from Line a and enter the difference 

in the appropriate column(s) of Line 5. Do not enter a number less than zero. Do not include 

any part of the operating expenses entered on Line b as a deduction in Part V.

a. Gross receipts $

b. Ordinary and necessary operating expenses $

c. Rent and other real property income Subtract Line b from Line a $ $

6 Interest, dividends and royalties. $ $

7 Pension and retirement income. $ $

8

Any amounts paid by another person or entity, on a regular basis, for the household 

expenses of the debtor or the debtor’s dependents, including child support paid for that 

purpose. Do not include alimony or separate maintenance payments or amounts paid by 

your spouse if Column B is completed. $ $

9

Unemployment compensation. Enter the amount in the appropriate column(s) of Line 9. 

However, if you contend that unemployment compensation received by you or your spouse 

was a benefit under the Social Security Act, do not list the amount of such compensation in 

Column A or B, but instead state the amount in the space below: 

Unemployment compensation claimed to 

be a benefit under the Social Security Act Debtor $ ________ Spouse $ _________ $ $

✔

600.00 4,796.42

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 3 of 54
B22A (Official Form 22A) (Chapter 7) (12/08) 3

10

Income from all other sources. Specify source and amount. If necessary, list additional 

sources on a separate page. Do not include alimony or separate maintenance payments 

paid by your spouse if Column B is completed, but include all other payments of 

alimony or separate maintenance. Do not include any benefits received under the Social 

Security Act or payments received as a victim of a war crime, crime against humanity, or as a 

victim of international or domestic terrorism. 

a. $

b. $

Total and enter on Line 10 $ $

11 Subtotal of Current Monthly Income for § 707(b)(7). Add Lines 3 thru 10 in Column A, 

and, if Column B is completed, add Lines 3 through 10 in Column B. Enter the total(s). $ $

12

Total Current Monthly Income for § 707(b)(7). If Column B has been completed, add 

Line 11, Column A to Line 11, Column B, and enter the total. If Column B has not been 

completed, enter the amount from Line 11, Column A. $

Part III. APPLICATION OF § 707(b)(7) EXCLUSION

13 Annualized Current Monthly Income for § 707(b)(7). Multiply the amount from Line 12 by the number 

12 and enter the result. $

14

Applicable median family income. Enter the median family income for the applicable state and household 

size. (This information is available by family size at www.usdoj.gov/ust/ or from the clerk of the 

bankruptcy court.) 

a. Enter debtor’s state of residence: _______________ b. Enter debtor’s household size: __________ $

15

Application of Section 707(b)(7). Check the applicable box and proceed as directed. 

The amount on Line 13 is less than or equal to the amount on Line 14. Check the box for “The presumption does 

not arise” at the top of page 1 of this statement, and complete Part VIII; do not complete Parts IV, V, VI or VII. 

The amount on Line 13 is more than the amount on Line 14. Complete the remaining parts of this statement.

Complete Parts IV, V, VI, and VII of this statement only if required. (See Line 15.) 

Part IV. CALCULATION OF CURRENT MONTHLY INCOME FOR § 707(b)(2) 

16 Enter the amount from Line 12. $

17

Marital adjustment. If you checked the box at Line 2.c, enter on Line 17 the total of any income listed in 

Line 11, Column B that was NOT paid on a regular basis for the household expenses of the debtor or the 

debtor’s dependents. Specify in the lines below the basis for excluding the Column B income (such as 

payment of the spouse’s tax liability or the spouse’s support of persons other than the debtor or the debtor’s 

dependents) and the amount of income devoted to each purpose. If necessary, list additional adjustments on 

a separate page. If you did not check box at Line 2.c, enter zero. 

a. $

b. $

c. $

Total and enter on Line 17. $

18 Current monthly income for § 707(b)(2). Subtract Line 17 from Line 16 and enter the result. $

Part V. CALCULATION OF DEDUCTIONS FROM INCOME

Subpart A: Deductions under Standards of the Internal Revenue Service (IRS)

19A

National Standards: food, clothing and other items. Enter in Line 19A the “Total” amount from IRS 

National Standards for Food, Clothing and Other Items for the applicable household size. (This information 

is available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court.) $

600.00 4,796.42

5,396.42

64,757.04

Illinois 4 81,465.00

✔

5,396.42

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 4 of 54
B22A (Official Form 22A) (Chapter 7) (12/08) 4

19B 

National Standards: health care. Enter in Line a1 below the amount from IRS National Standards for Outof-Pocket Health Care for persons under 65 years of age, and in Line a2 the IRS National Standards for Outof-Pocket Health Care for persons 65 years of age or older. (This information is available at 

www.usdoj.gov/ust/ or from the clerk of the bankruptcy court.) Enter in Line b1 the number of members of 

your household who are under 65 years of age, and enter in Line b2 the number of members of your 

household who are 65 years of age or older. (The total number of household members must be the same as 

the number stated in Line 14b.) Multiply Line a1 by Line b1 to obtain a total amount for household members 

under 65, and enter the result in Line c1. Multiply Line a2 by Line b2 to obtain a total amount for household 

members 65 and older, and enter the result in Line c2. Add Lines c1 and c2 to obtain a total health care 

amount, and enter the result in Line 19B. 

Household members under 65 years of age Household members 65 years of age or older

a1. Allowance per member a2. Allowance per member

b1. Number of members b2. Number of members

c1. Subtotal c2. Subtotal $

20A

Local Standards: housing and utilities; non-mortgage expenses. Enter the amount of the IRS Housing and 

Utilities Standards; non-mortgage expenses for the applicable county and household size. (This information 

is available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court). $

20B

Local Standards: housing and utilities; mortgage/rent expense. Enter, in Line a below, the amount of the 

IRS Housing and Utilities Standards; mortgage/rent expense for your county and household size (this 

information is available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court); enter on Line b the 

total of the Average Monthly Payments for any debts secured by your home, as stated in Line 42; subtract 

Line b from Line a and enter the result in Line 20B. Do not enter an amount less than zero. 

a. IRS Housing and Utilities Standards; mortgage/rental expense $

b. Average Monthly Payment for any debts secured by your home, 

if any, as stated in Line 42 $

c. Net mortgage/rental expense Subtract Line b from Line a. $

21

Local Standards: housing and utilities; adjustment. If you contend that the process set out in Lines 20A 

and 20B does not accurately compute the allowance to which you are entitled under the IRS Housing and 

Utilities Standards, enter any additional amount to which you contend you are entitled, and state the basis for 

your contention in the space below: 

$

22A

Local Standards: transportation; vehicle operation/public transportation expense. You are entitled to 

an expense allowance in this category regardless of whether you pay the expenses of operating a vehicle and 

regardless of whether you use public transportation.

Check the number of vehicles for which you pay the operating expenses or for which the operating expenses 

are included as a contribution to your household expenses in Line 8. 

 0 1 2 or more. 

If you checked 0, enter on Line 22A the “Public Transportation” amount from IRS Local Standards: 

Transportation. If you checked 1 or 2 or more, enter on Line 22A the “Operating Costs” amount from IRS 

Local Standards: Transportation for the applicable number of vehicles in the applicable Metropolitan 

Statistical Area or Census Region. (These amounts are available at www.usdoj.gov/ust/ or from the clerk of 

the bankruptcy court.) $

22B 

Local Standards: transportation; additional public transportation expense. If you pay the operating 

expenses for a vehicle and also use public transportation, and you contend that you are entitled to an 

additional deduction for your public transportation expenses, enter on Line 22B the “Public Transportation” 

amount from IRS Local Standards: Transportation. (This amount is available at www.usdoj.gov/ust/ or from 

the clerk of the bankruptcy court.) $

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 5 of 54
B22A (Official Form 22A) (Chapter 7) (12/08) 5

23

Local Standards: transportation ownership/lease expense; Vehicle 1. Check the number of vehicles for 

which you claim an ownership/lease expense. (You may not claim an ownership/lease expense for more than 

two vehicles.) 

 1 2 or more. 

Enter, in Line a below, the “Ownership Costs” for “One Car” from the IRS Local Standards: Transportation 

(available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court); enter in Line b the total of the 

Average Monthly Payments for any debts secured by Vehicle 1, as stated in Line 42; subtract Line b from 

Line a and enter the result in Line 23. Do not enter an amount less than zero. 

a. IRS Transportation Standards, Ownership Costs $

b. Average Monthly Payment for any debts secured by Vehicle 1, 

as stated in Line 42 $

c. Net ownership/lease expense for Vehicle 1 Subtract Line b from Line a. $

24

Local Standards: transportation ownership/lease expense; Vehicle 2. Complete this Line only if you 

checked the “2 or more” Box in Line 23. 

Enter, in Line a below, the “Ownership Costs” for “One Car” from the IRS Local Standards: Transportation 

(available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court); enter in Line b the total of the 

Average Monthly Payments for any debts secured by Vehicle 2, as stated in Line 42; subtract Line b from 

Line a and enter the result in Line 24. Do not enter an amount less than zero. 

a. IRS Transportation Standards, Ownership Costs $

b. Average Monthly Payment for any debts secured by Vehicle 2, 

as stated in Line 42 $

c. Net ownership/lease expense for Vehicle 2 Subtract Line b from Line a. $

25

Other Necessary Expenses: taxes. Enter the total average monthly expense that you actually incur for all 

federal, state and local taxes, other than real estate and sales taxes, such as income taxes, self-employment 

taxes, social-security taxes, and Medicare taxes. Do not include real estate or sales taxes. $

26

Other Necessary Expenses: involuntary deductions for employment. Enter the total average monthly 

payroll deductions that are required for your employment, such as retirement contributions, union dues, and 

uniform costs. Do not include discretionary amounts, such as voluntary 401(k) contributions. $

27

Other Necessary Expenses: life insurance. Enter total average monthly premiums that you actually pay for 

term life insurance for yourself. Do not include premiums for insurance on your dependents, for whole 

life or for any other form of insurance. $

28

Other Necessary Expenses: court-ordered payments. Enter the total monthly amount that you are 

required to pay pursuant to the order of a court or administrative agency, such as spousal or child support 

payments. Do not include payments on past due obligations included in Line 44. $

29

Other Necessary Expenses: education for employment or for a physically or mentally challenged child. 

Enter the total average monthly amount that you actually expend for education that is a condition of 

employment and for education that is required for a physically or mentally challenged dependent child for 

whom no public education providing similar services is available. $

30

Other Necessary Expenses: childcare. Enter the total average monthly amount that you actually expend on 

childcare—such as baby-sitting, day care, nursery and preschool. Do not include other educational 

payments. $

31

Other Necessary Expenses: health care. Enter the total average monthly amount that you actually expend 

on health care that is required for the health and welfare of yourself or your dependents, that is not 

reimbursed by insurance or paid by a health savings account, and that is in excess of the amount entered in 

Line 19B. Do not include payments for health insurance or health savings accounts listed in Line 34. $

32

Other Necessary Expenses: telecommunication services. Enter the total average monthly amount that you 

actually pay for telecommunication services other than your basic home telephone and cell phone service—

such as pagers, call waiting, caller id, special long distance, or internet service—to the extent necessary for 

your health and welfare or that of your dependents. Do not include any amount previously deducted. $

33 Total Expenses Allowed under IRS Standards. Enter the total of Lines 19 through 32. $

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 6 of 54
B22A (Official Form 22A) (Chapter 7) (12/08) 6

Subpart B: Additional Living Expense Deductions 

Note: Do not include any expenses that you have listed in Lines 19-32

34

Health Insurance, Disability Insurance, and Health Savings Account Expenses. List the monthly 

expenses in the categories set out in lines a-c below that are reasonably necessary for yourself, your spouse, 

or your dependents. 

a. Health Insurance $

b. Disability Insurance $

c. Health Savings Account $

Total and enter on Line 34 $

If you do not actually expend this total amount, state your actual total average monthly expenditures in the 

space below: 

$ ____________ 

35

Continued contributions to the care of household or family members. Enter the total average actual 

monthly expenses that you will continue to pay for the reasonable and necessary care and support of an 

elderly, chronically ill, or disabled member of your household or member of your immediate family who is 

unable to pay for such expenses. $

36

Protection against family violence. Enter the total average reasonably necessary monthly expenses that you 

actually incurred to maintain the safety of your family under the Family Violence Prevention and Services 

Act or other applicable federal law. The nature of these expenses is required to be kept confidential by the 

court. $

37

Home energy costs. Enter the total average monthly amount, in excess of the allowance specified by IRS 

Local Standards for Housing and Utilities, that you actually expend for home energy costs. You must 

provide your case trustee with documentation of your actual expenses, and you must demonstrate that 

the additional amount claimed is reasonable and necessary. $

38

Education expenses for dependent children less than 18. Enter the total average monthly expenses that 

you actually incur, not to exceed $137.50 per child, for attendance at a private or public elementary or 

secondary school by your dependent children less than 18 years of age. You must provide your case trustee 

with documentation of your actual expenses, and you must explain why the amount claimed is 

reasonable and necessary and not already accounted for in the IRS Standards. $

39

Additional food and clothing expense. Enter the total average monthly amount by which your food and 

clothing expenses exceed the combined allowances for food and clothing (apparel and services) in the IRS 

National Standards, not to exceed 5% of those combined allowances. (This information is available at 

www.usdoj.gov/ust/ or from the clerk of the bankruptcy court.) You must demonstrate that the additional 

amount claimed is reasonable and necessary. $

40 Continued charitable contributions. Enter the amount that you will continue to contribute in the form of 

cash or financial instruments to a charitable organization as defined in 26 U.S.C. § 170(c)(1)-(2). $

41 Total Additional Expense Deductions under § 707(b). Enter the total of Lines 34 through 40 

$

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 7 of 54
B22A (Official Form 22A) (Chapter 7) (12/08) 7

Subpart C: Deductions for Debt Payment

42

Future payments on secured claims. For each of your debts that is secured by an interest in property that 

you own, list the name of the creditor, identify the property securing the debt, state the Average Monthly 

Payment, and check whether the payment includes taxes or insurance. The Average Monthly Payment is the 

total of all amounts scheduled as contractually due to each Secured Creditor in the 60 months following the 

filing of the bankruptcy case, divided by 60. If necessary, list additional entries on a separate page. Enter 

the total of the Average Monthly Payments on Line 42. 

Name of 

Creditor

Property Securing the Debt Average 

Monthly 

Payment

Does payment 

include taxes 

or insurance?

a. $  yes  no

b. $  yes  no

c. $  yes  no

Total: Add 

Lines a, b and c. $

43

Other payments on secured claims. If any of debts listed in Line 42 are secured by your primary 

residence, a motor vehicle, or other property necessary for your support or the support of your dependents, 

you may include in your deduction 1/60th of any amount (the “cure amount”) that you must pay the creditor 

in addition to the payments listed in Line 42, in order to maintain possession of the property. The cure 

amount would include any sums in default that must be paid in order to avoid repossession or foreclosure. 

List and total any such amounts in the following chart. If necessary, list additional entries on a separate 

page. 

Name of 

Creditor

Property Securing the Debt 1/60th of the Cure Amount

a. $

b. $

c. $

Total: Add Lines a, b and c $

44

Payments on prepetition priority claims. Enter the total amount, divided by 60, of all priority claims, such 

as priority tax, child support and alimony claims, for which you were liable at the time of your bankruptcy 

filing. Do not include current obligations, such as those set out in Line 28. $

45

Chapter 13 administrative expenses. If you are eligible to file a case under chapter 13, complete the 

following chart, multiply the amount in line a by the amount in line b, and enter the resulting administrative 

expense.

a. Projected average monthly chapter 13 plan payment. $

b. Current multiplier for your district as determined under schedules issued 

by the Executive Office for United States Trustees. (This information is 

available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy 

court.) x

c. Average monthly administrative expense of chapter 13 case Total: Multiply Lines 

a and b $

46 Total Deductions for Debt Payment. Enter the total of Lines 42 through 45. $

Subpart D: Total Deductions from Income

47 Total of all deductions allowed under § 707(b)(2). Enter the total of Lines 33, 41, and 46. $

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 8 of 54
B22A (Official Form 22A) (Chapter 7) (12/08) 8

Part VI. DETERMINATION OF § 707(b)(2) PRESUMPTION

48 Enter the amount from Line 18 (Current monthly income for § 707(b)(2)) $

49 Enter the amount from Line 47 (Total of all deductions allowed under § 707(b)(2)) $

50 Monthly disposable income under § 707(b)(2). Subtract Line 49 from Line 48 and enter the result $

51 60-month disposable income under § 707(b)(2). Multiply the amount in Line 50 by the number 60 and 

enter the result. $

52

Initial presumption determination. Check the applicable box and proceed as directed. 

The amount on Line 51 is less than $6,575 Check the box for “The presumption does not arise” at the top of page 1 

of this statement, and complete the verification in Part VIII. Do not complete the remainder of Part VI.

The amount set forth on Line 51 is more than $10,950. Check the box for “The presumption arises” at the top of 

page 1 of this statement, and complete the verification in Part VIII. You may also complete Part VII. Do not complete 

the remainder of Part VI.

The amount on Line 51 is at least $6,575, but not more than $10,950. Complete the remainder of Part VI (Lines 53 

through 55).

53 Enter the amount of your total non-priority unsecured debt $

54 Threshold debt payment amount. Multiply the amount in Line 53 by the number 0.25 and enter the result. $

55

Secondary presumption determination. Check the applicable box and proceed as directed.

The amount on Line 51 is less than the amount on Line 54. Check the box for “The presumption does not arise” at 

the top of page 1 of this statement, and complete the verification in Part VIII. 

The amount on Line 51 is equal to or greater than the amount on Line 54. Check the box for “The presumption 

arises” at the top of page 1 of this statement, and complete the verification in Part VIII. You may also complete Part 

VII.

Part VII: ADDITIONAL EXPENSE CLAIMS

56

Other Expenses. List and describe any monthly expenses, not otherwise stated in this form, that are required for the health 

and welfare of you and your family and that you contend should be an additional deduction from your current monthly 

income under § 707(b)(2)(A)(ii)(I). If necessary, list additional sources on a separate page. All figures should reflect your 

average monthly expense for each item. Total the expenses.

Expense Description Monthly Amount

a. $

b. $

c. $

Total: Add Lines a, b and c $

Part VIII: VERIFICATION

57

I declare under penalty of perjury that the information provided in this statement is true and correct. (If this is a joint case, 

both debtors must sign.)

Date: _________________ Signature: ________________________ (Debtor)

Date: _________________ Signature: ________________________ (Joint Debtor, if any)

01/12/2010 /s/ Ruby Favela

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 9 of 54
B 1 (Official Form 1) (1/08) 

United States Bankruptcy Court 

Voluntary Petition

Name of Debtor (if individual, enter Last, First, Middle): 

 

Name of Joint Debtor (Spouse) (Last, First, Middle): 

 

All Other Names used by the Debtor in the last 8 years 

(include married, maiden, and trade names): 

 

All Other Names used by the Joint Debtor in the last 8 years 

(include married, maiden, and trade names): 

 

Last four digits of Soc. Sec. or Indvidual-Taxpayer I.D. (ITIN) No./Complete EIN

(if more than one, state all): 

 

Last four digits of Soc. Sec. or Indvidual-Taxpayer I.D. (ITIN) No./Complete EIN

(if more than one, state all): 

Street Address of Debtor (No. and Street, City, and State): 

 

 

 

 ZIP CODE 

Street Address of Joint Debtor (No. and Street, City, and State): 

 

 

 

 ZIP CODE 

County of Residence or of the Principal Place of Business: 

 

County of Residence or of the Principal Place of Business: 

 

Mailing Address of Debtor (if different from street address): 

 

 

 

 ZIP CODE 

Mailing Address of Joint Debtor (if different from street address): 

 

 

 

 ZIP CODE 

Location of Principal Assets of Business Debtor (if different from street address above): 

 ZIP CODE 

Type of Debtor 

(Form of Organization) 

(Check one box.) 

 Individual (includes Joint Debtors) 

 See Exhibit D on page 2 of this form. 

 Corporation (includes LLC and LLP) 

 Partnership 

 Other (If debtor is not one of the above entities, 

check this box and state type of entity below.) 

__________________________________________ 

Nature of Business 

(Check one box.) 

 Health Care Business 

 Single Asset Real Estate as defined in 

11 U.S.C. § 101(51B) 

 Railroad 

 Stockbroker 

 Commodity Broker 

 Clearing Bank 

 Other 

___________________________________ 

Tax-Exempt Entity

(Check box, if applicable.) 

 Debtor is a tax-exempt organization 

 under Title 26 of the United States 

 Code (the Internal Revenue Code). 

Chapter of Bankruptcy Code Under Which 

the Petition is Filed (Check one box.) 

Chapter 7 Chapter 15 Petition for 

 Chapter 9 Recognition of a Foreign 

 Chapter 11 Main Proceeding 

 Chapter 12 Chapter 15 Petition for 

 Chapter 13 Recognition of a Foreign 

 Nonmain Proceeding 

Nature of Debts 

(Check one box.) 

 Debts are primarily consumer Debts are primarily 

 debts, defined in 11 U.S.C. business debts. 

 § 101(8) as “incurred by an 

 individual primarily for a 

 personal, family, or house- 

 hold purpose.” 

Filing Fee (Check one box.) 

 Full Filing Fee attached. 

 Filing Fee to be paid in installments (applicable to individuals only). Must attach 

signed application for the court’s consideration certifying that the debtor is 

unable to pay fee except in installments. Rule 1006(b). See Official Form 3A. 

 Filing Fee waiver requested (applicable to chapter 7 individuals only). Must 

attach signed application for the court’s consideration. See Official Form 3B. 

Chapter 11 Debtors 

Check one box: 

 Debtor is a small business debtor as defined in 11 U.S.C. § 101(51D). 

 Debtor is not a small business debtor as defined in 11 U.S.C. § 101(51D). 

Check if: 

 Debtor’s aggregate noncontingent liquidated debts (excluding debts owed to 

insiders or affiliates) are less than $2,190,000. 

 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 

Check all applicable boxes: 

 A plan is being filed with this petition. 

 Acceptances of the plan were solicited prepetition from one or more classes 

of creditors, in accordance with 11 U.S.C. § 1126(b).

Statistical/Administrative Information 

 Debtor estimates that funds will be available for distribution to unsecured creditors. 

 Debtor estimates that, after any exempt property is excluded and administrative expenses paid, there will be no funds available for 

distribution to unsecured creditors. 

THIS SPACE IS FOR 

COURT USE ONLY

Estimated Number of Creditors 

1-49 50-99 100-199 200-999 1,000-

5,000 

5,001-

10,000 

10,001-

25,000 

25,001-

50,000 

50,001-

100,000 

Over

100,000 

Estimated Assets 

$0 to 

$50,000 

$50,001 to 

$100,000 

$100,001 to 

$500,000 

$500,001 

to $1 

million 

$1,000,001 

to $10 

million 

$10,000,001 

to $50 

million 

$50,000,001 

to $100 

million 

$100,000,001 

to $500 

million 

$500,000,001 

to $1 billion 

More than 

$1 billion 

Estimated Liabilities 

$0 to 

$50,000 

$50,001 to 

$100,000 

$100,001 to 

$500,000 

$500,001 

to $1 

million 

$1,000,001 

to $10 

million 

$10,000,001 

to $50 

million 

$50,000,001 

to $100 

million 

$100,000,001 

to $500 

million 

$500,000,001 

to $1 billion 

More than 

$1 billion 

 Northern District of Illinois

Favela, Ruby

Favela, Ruby L.

1846

1213 Greenvalley Street

Bensenville, IL

60106

DUPAGE

✔

✔

✔

✔

✔

✔

✔

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 10 of 54
B 1 (Official Form 1) (1/08) Page 2 

Voluntary Petition 

(This page must be completed and filed in every case.) 

Name of Debtor(s): 

 

 All Prior Bankruptcy Cases Filed Within Last 8 Years (If more than two, attach additional sheet.) 

Location 

Where Filed: 

Case Number: 

 

Date Filed: 

 

Location 

Where Filed: 

Case Number: 

 

Date Filed: 

 

Pending Bankruptcy Case Filed by any Spouse, Partner, or Affiliate of this Debtor (If more than one, attach additional sheet.) 

Name of Debtor: 

 

Case Number: 

 

Date Filed: 

 

District:

 

Relationship:

 

Judge:

 

Exhibit A 

(To be completed if debtor is required to file periodic reports (e.g., forms 10K and 

10Q) with the Securities and Exchange Commission pursuant to Section 13 or 15(d) 

of the Securities Exchange Act of 1934 and is requesting relief under chapter 11.) 

 Exhibit A is attached and made a part of this petition. 

Exhibit B 

(To be completed if debtor is an individual 

whose debts are primarily consumer debts.) 

I, the attorney for the petitioner named in the foregoing petition, declare that I 

have informed the petitioner that [he or she] may proceed under chapter 7, 11, 

12, or 13 of title 11, United States Code, and have explained the relief 

available under each such chapter. I further certify that I have delivered to the 

debtor the notice required by 11 U.S.C. § 342(b). 

X 

Signature of Attorney for Debtor(s) (Date) 

Exhibit C 

Does the debtor own or have possession of any property that poses or is alleged to pose a threat of imminent and identifiable harm to public health or safety? 

 Yes, and Exhibit C is attached and made a part of this petition. 

 No. 

Exhibit D

(To be completed by every individual debtor. If a joint petition is filed, each spouse must complete and attach a separate Exhibit D.) 

 Exhibit D completed and signed by the debtor is attached and made a part of this petition. 

If this is a joint petition: 

 Exhibit D also completed and signed by the joint debtor is attached and made a part of this petition. 

Information Regarding the Debtor - Venue 

(Check any applicable box.) 

 Debtor has been domiciled or has had a residence, principal place of business, or principal assets in this District for 180 days immediately 

preceding the date of this petition or for a longer part of such 180 days than in any other District. 

 There is a bankruptcy case concerning debtor’s affiliate, general partner, or partnership pending in this District. 

 Debtor is a debtor in a foreign proceeding and has its principal place of business or principal assets in the United States in this District, or 

has no principal place of business or assets in the United States but is a defendant in an action or proceeding [in a federal or state court] in 

this District, or the interests of the parties will be served in regard to the relief sought in this District. 

Certification by a Debtor Who Resides as a Tenant of Residential Property 

(Check all applicable boxes.) 

 Landlord has a judgment against the debtor for possession of debtor’s residence. (If box checked, complete the following.) 

 

 (Name of landlord that obtained judgment) 

 

 (Address of landlord) 

 Debtor claims that under applicable nonbankruptcy law, there are circumstances under which the debtor would be permitted to cure the 

entire monetary default that gave rise to the judgment for possession, after the judgment for possession was entered, and 

 Debtor has included with this petition the deposit with the court of any rent that would become due during the 30-day period after the 

filing of the petition. 

 Debtor certifies that he/she has served the Landlord with this certification. (11 U.S.C. § 362(l)). 

Favela, Ruby

 Northern District of Illinois

/s/ John Haderlein, ESQ. 01-12-2010

✔

✔

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 11 of 54
B 1 (Official Form) 1 (1/08) Page 3

Voluntary Petition 

(This page must be completed and filed in every case.) 

Name of Debtor(s): 

Signatures 

Signature(s) of Debtor(s) (Individual/Joint) 

I declare under penalty of perjury that the information provided in this petition is true 

and correct. 

[If petitioner is an individual whose debts are primarily consumer debts and has 

chosen to file under chapter 7] I am aware that I may proceed under chapter 7, 11, 12 

or 13 of title 11, United States Code, understand the relief available under each such 

chapter, and choose to proceed under chapter 7. 

[If no attorney represents me and no bankruptcy petition preparer signs the petition] I 

have obtained and read the notice required by 11 U.S.C. § 342(b). 

I request relief in accordance with the chapter of title 11, United States Code, 

specified in this petition. 

X 

 Signature of Debtor 

X 

 Signature of Joint Debtor 

 

 Telephone Number (if not represented by attorney) 

 Date 

Signature of a Foreign Representative 

I declare under penalty of perjury that the information provided in this petition is true 

and correct, that I am the foreign representative of a debtor in a foreign proceeding, 

and that I am authorized to file this petition. 

(Check only one box.) 

 I request relief in accordance with chapter 15 of title 11, United States Code. 

 Certified copies of the documents required by 11 U.S.C. § 1515 are attached. 

 Pursuant to 11 U.S.C. § 1511, I request relief in accordance with the 

 chapter of title 11 specified in this petition. A certified copy of the 

 order granting recognition of the foreign main proceeding is attached. 

X 

 (Signature of Foreign Representative) 

 (Printed Name of Foreign Representative) 

 

 Date 

Signature of Attorney* 

X 

 Signature of Attorney for Debtor(s) 

 

 Printed Name of Attorney for Debtor(s) 

 

 Firm Name 

 

 Address 

 

 

 

 Telephone Number 

 Date 

*In a case in which § 707(b)(4)(D) applies, this signature also constitutes a 

certification that the attorney has no knowledge after an inquiry that the information 

in the schedules is incorrect. 

Signature of Debtor (Corporation/Partnership) 

I declare under penalty of perjury that the information provided in this petition is true 

and correct, and that I have been authorized to file this petition on behalf of the 

debtor. 

The debtor requests the relief in accordance with the chapter of title 11, United States 

Code, specified in this petition. 

X

 Signature of Authorized Individual 

 Printed Name of Authorized Individual 

 Title of Authorized Individual 

 Date 

Signature of Non-Attorney Bankruptcy Petition Preparer 

I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as 

defined in 11 U.S.C. § 110; (2) I prepared this document for compensation and have 

provided the debtor with a copy of this document and the notices and information 

required under 11 U.S.C. §§ 110(b), 110(h), and 342(b); and, (3) if rules or 

guidelines have been promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum 

fee for services chargeable by bankruptcy petition preparers, I have given the debtor 

notice of the maximum amount before preparing any document for filing for a debtor 

or accepting any fee from the debtor, as required in that section. Official Form 19 is 

attached.

 Printed Name and title, if any, of Bankruptcy Petition Preparer 

 Social-Security number (If the bankruptcy petition preparer is not an individual, 

state the Social-Security number of the officer, principal, responsible person or 

partner of the bankruptcy petition preparer.) (Required by 11 U.S.C. § 110.) 

 Address 

X

 Date 

Signature of bankruptcy petition preparer or officer, principal, responsible person, or 

partner whose Social-Security number is provided above. 

Names and Social-Security numbers of all other individuals who prepared or assisted 

in preparing this document unless the bankruptcy petition preparer is not an 

individual. 

If more than one person prepared this document, attach additional sheets conforming 

to the appropriate official form for each person. 

A bankruptcy petition preparer’s failure to comply with the provisions of title 11 and 

the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or 

both. 11 U.S.C. § 110; 18 U.S.C. § 156.

Favela, Ruby

/s/ John Haderlein, ESQ.

John Haderlein, ESQ.

Law Offices of John Haderlein, ESQ.

815-C Country Club Drive

Libertyville, IL 60048

(312) 316-4614

01-12-2010

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 12 of 54
Official Form 1, Exhibit D (10/06) 

UNITED STATES BANKRUPTCY COURT 

_________________District of_________________ 

In re__________________________ Case No._____________ 

Debtor(s) (if known) 

EXHIBIT D - INDIVIDUAL DEBTOR=S STATEMENT OF COMPLIANCE WITH 

CREDIT COUNSELING REQUIREMENT 

Warning: You must be able to check truthfully one of the five statements regarding 

credit counseling listed below. If you cannot do so, you are not eligible to file a bankruptcy 

case, and the court can dismiss any case you do file. If that happens, you will lose whatever 

filing fee you paid, and your creditors will be able to resume collection activities against 

you. If your case is dismissed and you file another bankruptcy case later, you may be 

required to pay a second filing fee and you may have to take extra steps to stop creditors=

collection activities.

Every individual debtor must file this Exhibit D. If a joint petition is filed, each spouse 

must complete and file a separate Exhibit D. Check one of the five statements below and attach 

any documents as directed. 

Q 1. Within the 180 days before the filing of my bankruptcy case, I received a briefing 

from a credit counseling agency approved by the United States trustee or bankruptcy 

administrator that outlined the opportunities for available credit counseling and assisted me in 

performing a related budget analysis, and I have a certificate from the agency describing the 

services provided to me. Attach a copy of the certificate and a copy of any debt repayment plan 

developed through the agency.

Q 2. Within the 180 days before the filing of my bankruptcy case, I received a briefing 

from a credit counseling agency approved by the United States trustee or bankruptcy 

administrator that outlined the opportunities for available credit counseling and assisted me in 

performing a related budget analysis, but I do not have a certificate from the agency describing 

the services provided to me. You must file a copy of a certificate from the agency describing the 

services provided to you and a copy of any debt repayment plan developed through the agency 

no later than 15 days after your bankruptcy case is filed.

Northern Illinois

Favela, Ruby

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 13 of 54
Official Form 1, Exh. D (10/06) – Cont. 

2

Q 3. I certify that I requested credit counseling services from an approved agency but was 

unable to obtain the services during the five days from the time I made my request, and the 

following exigent circumstances merit a temporary waiver of the credit counseling requirement 

so I can file my bankruptcy case now. [Must be accompanied by a motion for determination by 

the court.][Summarize exigent circumstances here.] _________________________________ 

.

If the court is satisfied with the reasons stated in your motion, it will send you an 

order approving your request. You must still obtain the credit counseling briefing within 

the first 30 days after you file your bankruptcy case and promptly file a certificate from the 

agency that provided the briefing, together with a copy of any debt management plan 

developed through the agency. Any extension of the 30-day deadline can be granted only 

for cause and is limited to a maximum of 15 days. A motion for extension must be filed 

within the 30-day period. Failure to fulfill these requirements may result in dismissal of 

your case. If the court is not satisfied with your reasons for filing your bankruptcy case 

without first receiving a credit counseling briefing, your case may be dismissed.

Q 4. I am not required to receive a credit counseling briefing because of: [Check the 

applicable statement.] [Must be accompanied by a motion for determination by the court.]

 Q Incapacity. (Defined in 11 U.S.C. § 109(h)(4) as impaired by reason of mental 

illness or mental deficiency so as to be incapable of realizing and making rational 

decisions with respect to financial responsibilities.);

 Q Disability. (Defined in 11 U.S.C. § 109(h)(4) as physically impaired to the 

extent of being unable, after reasonable effort, to participate in a credit counseling 

briefing in person, by telephone, or through the Internet.);

 Q Active military duty in a military combat zone. 

Q 5. The United States trustee or bankruptcy administrator has determined that the credit 

counseling requirement of 11 U.S.C. ' 109(h) does not apply in this district.

I certify under penalty of perjury that the information provided above is true and 

correct.

Signature of Debtor: ________________________________ 

Date: _________________ 

/s/ Ruby Favela

01-10-2010

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 14 of 54
___________________________________

___________________________________

Certificate Number: 

CERTIFICATE OF COUNSELING

I CERTIFY that on _______________________, at _____________ o’clock ______________, 

______________________________________________ received from 

_____________________________________________________________________________, 

an agency approved pursuant to 11 U.S.C. § 111 to provide credit counseling in the 

_______________________________________, an individual [or group] briefing that complied 

with the provisions of 11 U.S.C. §§ 109(h) and 111. 

A debt repayment plan _________________. If a debt repayment plan was prepared, a copy of 

the debt repayment plan is attached to this certificate. 

This counseling session was conducted _____________________________. 

Date: _______________________ By

Name ___________________________________ 

Title

* Individuals who wish to file a bankruptcy case under title 11 of the United States Bankruptcy 

Code are required to file with the United States Bankruptcy Court a completed certificate of 

counseling from the nonprofit budget and credit counseling agency that provided the individual 

the counseling services and a copy of the debt repayment plan, if any, developed through the 

credit counseling agency. See 11 U.S.C. §§ 109(h) and 521(b). 

01267-ILN-CC-009550845

January 11, 2010 1:46 PM CST

Ruby L Favela

Money Management International, Inc.

Northern District of Illinois

was not prepared

by internet

January 11, 2010 /s/Erica Augustine

Erica Augustine

Counselor

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 15 of 54
B6 Summary (Official Form 6 - Summary) (12/07)

United States Bankruptcy Court

_______________ District Of ______________

In re ___________________________________, Case No. ___________________

Debtor

Chapter ____________

SUMMARY OF SCHEDULES

Indicate as to each schedule whether that schedule is attached and state the number of pages in each. Report the totals from Schedules A, B, D, E, F, I,

and J in the boxes provided. Add the amounts from Schedules A and B to determine the total amount of the debtor’s assets. Add the amounts of all

claims from Schedules D, E, and F to determine the total amount of the debtor’s liabilities. Individual debtors also must complete the “Statistical

Summary of Certain Liabilities and Related Data” if they file a case under chapter 7, 11, or 13.

NAME OF SCHEDULE

ATTACHED

(YES/NO) NO. OF SHEETS ASSETS LIABILITIES OTHER

A - Real Property $

B - Personal Property $

C - Property Claimed

 as Exempt

D - Creditors Holding

 Secured Claims

$

E - Creditors Holding Unsecured 

 Priority Claims

 (Total of Claims on Schedule E)

$

F - Creditors Holding Unsecured

 Nonpriority Claims

$

G - Executory Contracts and

 Unexpired Leases

H - Codebtors

I - Current Income of

 Individual Debtor(s)

$

J - Current Expenditures of Individual

 Debtors(s)

$

TOTAL $ $

Northern Illinois

Favela, Ruby

7

YES 1 200,000.00

YES 3 3,950.00

YES 1

YES 1 224,130.70

YES 2 0.00

YES 4 42,877.86

YES 1

YES 1

YES 1 4219.55

YES 1 4102.68

16 203,950.00 267,008.56

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 16 of 54
Form 6 - Statistical Summary (12/07)

United States Bankruptcy Court

_______________ District Of ______________

In re ___________________________________, Case No. ___________________

Debtor

Chapter ____________

STATISTICAL SUMMARY OF CERTAIN LIABILITIES AND RELATED DATA (28 U.S.C. § 159)

If you are an individual debtor whose debts are primarily consumer debts, as defined in § 101(8) of the Bankruptcy Code (11 U.S.C.

§ 101(8)), filing a case under chapter 7, 11 or 13, you must report all information requested below. 

Q Check this box if you are an individual debtor whose debts are NOT primarily consumer debts. You are not required to report any

information here.

This information is for statistical purposes only under 28 U.S.C. § 159.

Summarize the following types of liabilities, as reported in the Schedules, and total them.

Type of Liability Amount

Domestic Support Obligations (from Schedule E) $

Taxes and Certain Other Debts Owed to Governmental Units

(from Schedule E)

$

Claims for Death or Personal Injury While Debtor Was

Intoxicated (from Schedule E) (whether disputed or undisputed)

$

Student Loan Obligations (from Schedule F) $

Domestic Support, Separation Agreement, and Divorce Decree

Obligations Not Reported on Schedule E

$

Obligations to Pension or Profit-Sharing, and Other Similar

Obligations (from Schedule F)

$

TOTAL $

State the following:

Average Income (from Schedule I, Line 16) $

Average Expenses (from Schedule J, Line 18) $

Current Monthly Income (from Form 22A Line 12; OR, Form

22B Line 11; OR, Form 22C Line 20 )

$

State the following:

1. Total from Schedule D, “UNSECURED PORTION, IF

ANY” column

$

2. Total from Schedule E, “AMOUNT ENTITLED TO

PRIORITY” column.

$

3. Total from Schedule E, “AMOUNT NOT ENTITLED TO

PRIORITY, IF ANY” column

$

4. Total from Schedule F $

5. Total of non-priority unsecured debt (sum of 1, 3, and 4) $

Northern Illinois

Favela, Ruby

7

0.00

0.00

0.00

0.00

0.00

0.00

0.00

5396.42

4219.55

4102.68

0.00

0.00

 0.00

 42,877.86

 42,877.86

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 17 of 54
B6A (Official Form 6A) (12/07)

In re _____________________________________________, Case No. ______________________________

Debtor (If known)

SCHEDULE A - REAL PROPERTY

Except as directed below, list all real property in which the debtor has any legal, equitable, or future interest, including all property owned as a cotenant, community property, or in which the debtor has a life estate. Include any property in which the debtor holds rights and powers exercisable for

the debtor’s own benefit. If the debtor is married, state whether the husband, wife, both, or the marital community own the property by placing an “H,”

“W,” “J,” or “C” in the column labeled “Husband, Wife, Joint, or Community.” If the debtor holds no interest in real property, write “None” under

“Description and Location of Property.”

Do not include interests in executory contracts and unexpired leases on this schedule. List them in Schedule G - Executory Contracts and

Unexpired Leases.

If an entity claims to have a lien or hold a secured interest in any property, state the amount of the secured claim. See Schedule D. If no entity claims

to hold a secured interest in the property, write “None” in the column labeled “Amount of Secured Claim.”

If the debtor is an individual or if a joint petition is filed, state the amount of any exemption claimed in the property only in Schedule C - Property

Claimed as Exempt.

DESCRIPTION AND

LOCATION OF

PROPERTY

NATURE OF DEBTOR’S

INTEREST IN PROPERTY

CURRENT VALUE

OF DEBTOR’S

INTEREST IN

PROPERTY, WITHOUT

DEDUCTING ANY

SECURED CLAIM

OR EXEMPTION

AMOUNT OF

SECURED

CLAIM

Total


(Report also on Summary of Schedules.)

Favela, Ruby

1213 Greenvalley Street

Bensenville, IL 60106

(principal residence)

Fee Simple J $200,000.00 $224,130.70

200,000.00

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 18 of 54
B6B (Official Form 6B) (12/07)

In re _______________________________________________, Case No. _________________________

Debtor (If known)

SCHEDULE B - PERSONAL PROPERTY

Except as directed below, list all personal property of the debtor of whatever kind. If the debtor has no property in one or more of the categories,

place an “x” in the appropriate position in the column labeled “None.” If additional space is needed in any category, attach a separate sheet properly

identified with the case name, case number, and the number of the category. If the debtor is married, state whether the husband, wife, both, or the marital

community own the property by placing an “H,” “W,” “J,” or “C” in the column labeled “Husband, Wife, Joint, or Community.” If the debtor is an

individual or a joint petition is filed, state the amount of any exemptions claimed only in Schedule C - Property Claimed as Exempt.

Do not list interests in executory contracts and unexpired leases on this schedule. List them in Schedule G - Executory Contracts and

Unexpired Leases.

If the property is being held for the debtor by someone else, state that person’s name and address under “Description and Location of Property.” 

If the property is being held for a minor child, simply state the child's initials and the name and address of the child's parent or guardian, such as

"A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m).

TYPE OF PROPERTY

N

O

N

E

DESCRIPTION AND LOCATION

OF PROPERTY

CURRENT VALUE OF

DEBTOR’S INTEREST 

IN PROPERTY, WITHOUT DEDUCTING ANY

SECURED CLAIM

OR EXEMPTION

1. Cash on hand.

2. Checking, savings or other financial accounts, certificates of deposit

or shares in banks, savings and loan,

thrift, building and loan, and homestead associations, or credit unions,

brokerage houses, or cooperatives.

3. Security deposits with public utilities, telephone companies, landlords, and others.

4. Household goods and furnishings,

including audio, video, and computer

equipment.

5. Books; pictures and other art

objects; antiques; stamp, coin,

record, tape, compact disc, and other

collections or collectibles.

6. Wearing apparel.

7. Furs and jewelry.

8. Firearms and sports, photographic, and other hobby equipment.

9. Interests in insurance policies.

Name insurance company of each 

policy and itemize surrender or

refund value of each.

10. Annuities. Itemize and name

each issuer.

11. Interests in an education IRA as

defined in 26 U.S.C. § 530(b)(1) or under

a qualified State tuition plan as defined in

26 U.S.C. § 529(b)(1). Give particulars. 

(File separately the record(s) of any such

interest(s). 11 U.S.C. § 521(c).)

Favela, Ruby

$100.00

Checking - $100.00

Savings - $2,000.00

$2,100.00

x

Home $1,000.00

x

Home $750.00

x

x

x

x

x

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 19 of 54
B6B (Official Form 6B) (12/07) -- Cont.

In re ______________________________________________, Case No. _________________________

Debtor (If known)

SCHEDULE B - PERSONAL PROPERTY

(Continuation Sheet)

TYPE OF PROPERTY

N

O

N

E

DESCRIPTION AND LOCATION

OF PROPERTY

CURRENT VALUE OF

DEBTOR’S INTEREST 

IN PROPERTY, WITHOUT DEDUCTING ANY

SECURED CLAIM

OR EXEMPTION

12. Interests in IRA, ERISA, Keogh, or

other pension or profit sharing plans. 

Give particulars.

13. Stock and interests in incorporated

and unincorporated businesses.

Itemize. 

14. Interests in partnerships or joint

ventures. Itemize. 

15. Government and corporate bonds

and other negotiable and nonnegotiable instruments.

16. Accounts receivable.

17. Alimony, maintenance, support,

and property settlements to which the

debtor is or may be entitled. Give

particulars.

18. Other liquidated debts owed to 

debtor including tax refunds. Give

particulars.

19. Equitable or future interests, life

estates, and rights or powers exercisable

for the benefit of the debtor other than

those listed in Schedule A – Real

Property.

20. Contingent and noncontingent

interests in estate of a decedent, death

benefit plan, life insurance policy, or trust.

21. Other contingent and unliquidated

claims of every nature, including tax

refunds, counterclaims of the debtor, and

rights to setoff claims. Give estimated

value of each.

Favela, Ruby

x

x

x

x

x

x

x

x

x

x

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 20 of 54
B6B (Official Form 6B) (12/07) -- Cont.

In re _________________________________________________, Case No. _________________________

Debtor (If known)

SCHEDULE B - PERSONAL PROPERTY

(Continuation Sheet)

TYPE OF PROPERTY

N

O

N

E

DESCRIPTION AND LOCATION

OF PROPERTY

CURRENT VALUE OF

DEBTOR’S INTEREST 

IN PROPERTY, WITHOUT DEDUCTING ANY

SECURED CLAIM

OR EXEMPTION

22. Patents, copyrights, and other

intellectual property. Give particulars.

23. Licenses, franchises, and other general

intangibles. Give particulars.

24. Customer lists or other compilations

containing personally identifiable

information (as defined in 11 U.S.C.

 § 101(41A)) provided to the debtor by

individuals in connection with obtaining a

product or service from the debtor

primarily for personal, family, or

household purposes. 

 25. Automobiles, trucks, trailers,

and other vehicles and accessories.

26. Boats, motors, and accessories.

27. Aircraft and accessories.

28. Office equipment, furnishings,

and supplies.

29. Machinery, fixtures, equipment,

and supplies used in business.

30. Inventory.

31. Animals.

32. Crops - growing or harvested.

Give particulars.

33. Farming equipment and implements.

34. Farm supplies, chemicals, and feed.

35. Other personal property of any kind

not already listed. Itemize.

__________continuation sheets attached Total
 $

(Include amounts from any continuation

sheets attached. Report total also on

Summary of Schedules.)

Favela, Ruby

x

x

x

x

x

x

x

x

x

x

x

x

x

0 3,950.00

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 21 of 54
B6C (Official Form 6C) (12/07)

In re ____________________________________________, Case No. _________________________

Debtor (If known)

SCHEDULE C - PROPERTY CLAIMED AS EXEMPT

Debtor claims the exemptions to which debtor is entitled under:

(Check one box)

G 11 U.S.C. § 522(b)(2)

G 11 U.S.C. § 522(b)(3)

G Check if debtor claims a homestead exemption that exceeds

 $136,875.

DESCRIPTION OF PROPERTY

SPECIFY LAW

PROVIDING EACH

EXEMPTION

VALUE OF

CLAIMED

EXEMPTION

CURRENT

VALUE OF PROPERTY

WITHOUT DEDUCTING 

 EXEMPTION

Favela, Ruby

✔

Real estate located at 1213

Greenvalley Street,

Benesenville, IL 60106

(principal residence)

735 ILCS 5/12-901 $15,000.00 $200,000.00

Cash on Hand, Bank Accounts,

Household Goods, Wearing

Apparel

735 ILCS 5/12-1001(a) $4,000.00 $3,950.00

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 22 of 54
B6D (Official Form 6D) (12/07) 

 In re ____________________________________, Case No. __________________________________ 

 Debtor (If known)

SCHEDULE D - CREDITORS HOLDING SECURED CLAIMS

State the name, mailing address, including zip code, and last four digits of any account number of all entities holding claims secured by 

property of the debtor as of the date of filing of the petition. The complete account number of any account the debtor has with the creditor is useful 

to the trustee and the creditor and may be provided if the debtor chooses to do so. List creditors holding all types of secured interests such as 

judgment liens, garnishments, statutory liens, mortgages, deeds of trust, and other security interests. 

 List creditors in alphabetical order to the extent practicable. If a minor child is the creditor, state the child's initials and the name and 

address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 

and Fed. R. Bankr. P. 1007(m). If all secured creditors will not fit on this page, use the continuation sheet provided. 

 If any entity other than a spouse in a joint case may be jointly liable on a claim, place an “X” in the column labeled “Codebtor,” include the 

entity on the appropriate schedule of creditors, and complete Schedule H – Codebtors. If a joint petition is filed, state whether the husband, wife, 

both of them, or the marital community may be liable on each claim by placing an “H,” “W,” “J,” or “C” in the column labeled “Husband, Wife, 

Joint, or Community.” 

 If the claim is contingent, place an “X” in the column labeled “Contingent.” If the claim is unliquidated, place an “X” in the column 

labeled “Unliquidated.” If the claim is disputed, place an “X” in the column labeled “Disputed.” (You may need to place an “X” in more than one of 

these three columns.) 

 Total the columns labeled “Amount of Claim Without Deducting Value of Collateral” and “Unsecured Portion, if Any” in the boxes

labeled “Total(s)” on the last sheet of the completed schedule. Report the total from the column labeled “Amount of Claim Without Deducting Value 

of Collateral” also on the Summary of Schedules and, if the debtor is an individual with primarily consumer debts, report the total from the column 

labeled “Unsecured Portion, if Any” on the Statistical Summary of Certain Liabilities and Related Data. 

Check this box if debtor has no creditors holding secured claims to report on this Schedule D. 

CREDITOR’S NAME AND 

MAILING ADDRESS 

INCLUDING ZIP CODE AND 

AN ACCOUNT NUMBER 

(See Instructions Above.)

CODEBTOR

HUSBAND, WIFE, 

JOINT, OR 

COMMUNITY 

DATE CLAIM WAS 

INCURRED, 

NATURE OF LIEN , 

AND

DESCRIPTION 

AND VALUE OF 

PROPERTY

SUBJECT TO LIEN 

CONTINGENT 

UNLIQUIDATED 

DISPUTED

AMOUNT OF CLAIM 

WITHOUT

DEDUCTING VALUE 

OF COLLATERAL 

UNSECURED 

PORTION, IF 

ANY

ACCOUNT NO. 

VALUE $ 

 

ACCOUNT NO. 

VALUE $ 

 

ACCOUNT NO. 

VALUE $ 

 

____continuation sheets 

 attached 

 Subtotal  

(Total of this page) 

 $ $ 

 Total  

(Use only on last page) 

 $ $ 

 (Report also on Summary of 

Schedules.) 

(If applicable, report 

also on Statistical 

Summary of Certain 

Liabilities and Related 

Data.) 

Favela, Ruby

ACCOUNT NO. ****8392

Bank of America

Customer Service

P.O. Box 5170

Simi Valley, CA 93062-5170

February, 2008, 1st

mortgage related to 1213

Greenvalley Street,

Bensenville, IL 60106

(principal residence)

VALUE $200,000.00

$182,028.83 $0.00

ACCOUNT NO. ****3944

Green Tree Bankruptcy Department

P.O. Box 6154

Rapid City, SD 57709

February, 2008, 2nd

mortgage related to 1213

Greenvalley Street,

Bensenville, IL 60106

(principal residence)

VALUE $200,000.00

$42,101.87 $0.00

ACCOUNT NO.

VALUE $

0 224,130.70 0.00

224,130.70 0.00

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 23 of 54
B6D (Official Form 6D) (12/07) – Cont. 2

 

In re ____________________________________, Case No. __________________________________ 

 Debtor (if known)

SCHEDULE D - CREDITORS HOLDING SECURED CLAIMS 

(Continuation Sheet) 

CREDITOR’S NAME AND 

MAILING ADDRESS 

INCLUDING ZIP CODE 

AND AN ACCOUNT 

NUMBER

(See Instructions Above.)

CODEBTOR 

HUSBAND, WIFE, 

JOINT, OR 

COMMUNITY

DATE CLAIM WAS 

INCURRED, NATURE 

OF LIEN , AND 

DESCRIPTION AND 

VALUE OF PROPERTY 

SUBJECT TO LIEN 

CONTINGENT 

UNLIQUIDATED 

DISPUTED

AMOUNT OF CLAIM 

WITHOUT 

DEDUCTING VALUE 

OF COLLATERAL 

UNSECURED

PORTION, IF 

ANY

ACCOUNT NO. 

VALUE $ 

 

ACCOUNT NO. 

VALUE $ 

 

ACCOUNT NO. 

VALUE $

 

ACCOUNT NO. 

VALUE $

 

ACCOUNT NO. 

VALUE $

 

Sheet no.___of___continuation 

sheets attached to Schedule of 

Creditors Holding Secured 

Claims 

 Subtotal (s) 

(Total(s) of this page) 

 $ $ 

 Total(s)  

(Use only on last page) 

 $ $ 

 (Report also on 

Summary of Schedules.) 

(If applicable, 

report also on 

Statistical Summary 

of Certain 

Liabilities and 

Related Data.) 

ACCOUNT NO.

VALUE $

ACCOUNT NO.

VALUE $

ACCOUNT NO.

VALUE $

ACCOUNT NO.

VALUE $

ACCOUNT NO.

VALUE $

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 24 of 54
B6E (Official Form 6E) (12/07)

In re , Case No.

Debtor (if known)

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

A complete list of claims entitled to priority, listed separately by type of priority, is to be set forth on the sheets provided. Only holders of

unsecured claims entitled to priority should be listed in this schedule. In the boxes provided on the attached sheets, state the name, mailing address,

including zip code, and last four digits of the account number, if any, of all entities holding priority claims against the debtor or the property of the

debtor, as of the date of the filing of the petition. Use a separate continuation sheet for each type of priority and label each with the type of priority.

The complete account number of any account the debtor has with the creditor is useful to the trustee and the creditor and may be provided if the

debtor chooses to do so. If a minor child is a creditor, state the child's initials and the name and address of the child's parent or guardian, such as

"A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m).

If any entity other than a spouse in a joint case may be jointly liable on a claim, place an "X" in the column labeled "Codebtor," include the

entity on the appropriate schedule of creditors, and complete Schedule H-Codebtors. If a joint petition is filed, state whether the husband, wife,

both of them, or the marital community may be liable on each claim by placing an "H," "W," "J," or "C" in the column labeled "Husband, Wife,

Joint, or Community." If the claim is contingent, place an "X" in the column labeled "Contingent." If the claim is unliquidated, place an "X" in

the column labeled "Unliquidated." If the claim is disputed, place an "X" in the column labeled "Disputed." (You may need to place an "X" in more

than one of these three columns.)

Report the total of claims listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all claims listed on this Schedule

E in the box labeled “Total” on the last sheet of the completed schedule. Report this total also on the Summary of Schedules.

Report the total of amounts entitled to priority listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all amounts

entitled to priority listed on this Schedule E in the box labeled “Totals” on the last sheet of the completed schedule. Individual debtors with

primarily consumer debts report this total also on the Statistical Summary of Certain Liabilities and Related Data.

Report the total of amounts not entitled to priority listed on each sheet in the box labeled “Subtotals” on each sheet. Report the total of all

amounts not entitled to priority listed on this Schedule E in the box labeled “Totals” on the last sheet of the completed schedule. Individual debtors

with primarily consumer debts report this total also on the Statistical Summary of Certain Liabilities and Related Data.

 Check this box if debtor has no creditors holding unsecured priority claims to report on this Schedule E.

TYPES OF PRIORITY CLAIMS (Check the appropriate box(es) below if claims in that category are listed on the attached sheets.)

 Domestic Support Obligations 

Claims for domestic support that are owed to or recoverable by a spouse, former spouse, or child of the debtor, or the parent, legal guardian, or

responsible relative of such a child, or a governmental unit to whom such a domestic support claim has been assigned to the extent provided in

11 U.S.C. § 507(a)(1).

Extensions of credit in an involuntary case

Claims arising in the ordinary course of the debtor's business or financial affairs after the commencement of the case but before the earlier of the

appointment of a trustee or the order for relief. 11 U.S.C. § 507(a)(3).

Wages, salaries, and commissions

Wages, salaries, and commissions, including vacation, severance, and sick leave pay owing to employees and commissions owing to qualifying

independent sales representatives up to $10,950* per person earned within 180 days immediately preceding the filing of the original petition, or the

cessation of business, whichever occurred first, to the extent provided in 11 U.S.C. § 507(a)(4).

Contributions to employee benefit plans

Money owed to employee benefit plans for services rendered within 180 days immediately preceding the filing of the original petition, or the

cessation of business, whichever occurred first, to the extent provided in 11 U.S.C. § 507(a)(5).

Favela, Ruby

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 25 of 54
B6E (Official Form 6E) (12/07) – Cont.

In re , Case No. 

Debtor (if known)

Certain farmers and fishermen

Claims of certain farmers and fishermen, up to $5,400* per farmer or fisherman, against the debtor, as provided in 11 U.S.C. § 507(a)(6).

Deposits by individuals

Claims of individuals up to $2,425* for deposits for the purchase, lease, or rental of property or services for personal, family, or household use,

that were not delivered or provided. 11 U.S.C. § 507(a)(7).

Taxes and Certain Other Debts Owed to Governmental Units

Taxes, customs duties, and penalties owing to federal, state, and local governmental units as set forth in 11 U.S.C. § 507(a)(8).

Commitments to Maintain the Capital of an Insured Depository Institution

Claims based on commitments to the FDIC, RTC, Director of the Office of Thrift Supervision, Comptroller of the Currency, or Board of

Governors of the Federal Reserve System, or their predecessors or successors, to maintain the capital of an insured depository institution. 11 U.S.C.

§ 507 (a)(9).

Claims for Death or Personal Injury While Debtor Was Intoxicated

Claims for death or personal injury resulting from the operation of a motor vehicle or vessel while the debtor was intoxicated from using alcohol, a

drug, or another substance. 11 U.S.C. § 507(a)(10).

* Amounts are subject to adjustment on April 1, 2010, and every three years thereafter with respect to cases commenced on or after the date of

adjustment.

____ continuation sheets attached

Favela, Ruby

0

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 26 of 54
B6F (Official Form 6F) (12/07)

In re __________________________________________, Case No. _________________________________

Debtor (if known)

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

State the name, mailing address, including zip code, and last four digits of any account number, of all entities holding unsecured claims without priority against

the debtor or the property of the debtor, as of the date of filing of the petition. The complete account number of any account the debtor has with the creditor is

useful to the trustee and the creditor and may be provided if the debtor chooses to do so. If a minor child is a creditor, state the child's initials and the name and

address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed.

R. Bankr. P. 1007(m). Do not include claims listed in Schedules D and E. If all creditors will not fit on this page, use the continuation sheet provided.

If any entity other than a spouse in a joint case may be jointly liable on a claim, place an “X” in the column labeled “Codebtor,” include the entity on the

appropriate schedule of creditors, and complete Schedule H - Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital

community may be liable on each claim by placing an “H,” “W,” “J,” or “C” in the column labeled “Husband, Wife, Joint, or Community.”

If the claim is contingent, place an “X” in the column labeled “Contingent.” If the claim is unliquidated, place an “X” in the column labeled “Unliquidated.”

If the claim is disputed, place an “X” in the column labeled “Disputed.” (You may need to place an “X” in more than one of these three columns.)

Report the total of all claims listed on this schedule in the box labeled “Total” on the last sheet of the completed schedule. Report this total also on the

Summary of Schedules and, if the debtor is an individual with primarily consumer debts, report this total also on the Statistical Summary of Certain Liabilities

and Related Data..

G Check this box if debtor has no creditors holding unsecured claims to report on this Schedule F.

CREDITOR’S NAME,

 MAILING ADDRESS

 INCLUDING ZIP CODE,

 AND ACCOUNT NUMBER

(See instructions above.)

CODEBTOR

HUSBAND, WIFE,

JOINT, OR

COMMUNITY

DATE CLAIM WAS

INCURRED AND

CONSIDERATION FOR

CLAIM.

 IF CLAIM IS SUBJECT TO

SETOFF, SO STATE.

CONTINGENT

UNLIQUIDATED

DISPUTED

AMOUNT OF

CLAIM

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

Subtotal
 $

_____continuation sheets attached Total


 (Use only on last page of the completed Schedule F.)

 (Report also on Summary of Schedules and, if applicable, on the Statistical

Summary of Certain Liabilities and Related Data.)

$

Favela, Ruby

****1990

NCO Financial Systems, Inc.

P.O. Box 15630

Dept. 02

Wilmington, DE 19850

January, 2009 (Barclays Bank of

Delaware)

$5419.20

 9242

NCO Financial Systems, Inc.

P.O. Box 15630

Dept. 72

Wilmington, DE 19850

January, 2009 (Department Store

National Bank)

$2280.86

** **3-470

Victoria's Secret

13526 Nacogdoches Road

San Antonio, TX 78217-1274

February, 2009

$91.91

 927-2

GE Money Bank (JC Penney)

Attn: Bankruptcy Department

P.O. Box 103104

Roswell, GA 30076

January, 2009

$542.06

3

8,334.03

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 27 of 54
B6F (Official Form 6F) (12/07) - Cont. 

In re __________________________________________, Case No. _________________________________

Debtor (if known)

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

(Continuation Sheet)

CREDITOR’S NAME,

 MAILING ADDRESS

 INCLUDING ZIP CODE,

 AND ACCOUNT NUMBER

(See instructions above.)

CODEBTOR

HUSBAND, WIFE,

JOINT, OR

COMMUNITY

DATE CLAIM WAS

INCURRED AND

CONSIDERATION FOR

CLAIM.

 IF CLAIM IS SUBJECT TO

SETOFF, SO STATE.

CONTINGENT

UNLIQUIDATED

DISPUTED

AMOUNT OF

CLAIM

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

Sheet no.___of___ continuation sheets attached

to Schedule of Creditors Holding Unsecured

Nonpriority Claims

Subtotal
 $

Total


 (Use only on last page of the completed Schedule F.)

 (Report also on Summary of Schedules and, if applicable on the Statistical

Summary of Certain Liabilities and Related Data.)

$

Favela, Ruby

PNC** **0909/WWR 9382

Weltman, Weisberg & Reis (PNC)

323 W. Lakeside, Suite 200

Cleveland, OH 44113-1009

April, 2009 (PNC Bank, NA)

$6683.92

** **6049

Premier Credit Corp (Rogers & Holland)

4245 Brockton Drive

Suite B

Kentwood, MU 49512

April, 2009

$1584.65

Rogers Enterprise (Rogers & Holland)

P.O. Box 879

Matteson, IL 60443

April, 2009

$1584.65

 9093

First Source (Target National Bank)

205 Bryant Woods South

Amherst, NY 14228

June, 2009

$3689.80

** **8601

HSBC Card Services

P.O. Box 60102

City of Industry, CA 91716-0102

April, 2009

$266.05

1 3 13,809.07

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 28 of 54
B6F (Official Form 6F) (12/07) - Cont. 

In re __________________________________________, Case No. _________________________________

Debtor (if known)

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

(Continuation Sheet)

CREDITOR’S NAME,

 MAILING ADDRESS

 INCLUDING ZIP CODE,

 AND ACCOUNT NUMBER

(See instructions above.)

CODEBTOR

HUSBAND, WIFE,

JOINT, OR

COMMUNITY

DATE CLAIM WAS

INCURRED AND

CONSIDERATION FOR

CLAIM.

 IF CLAIM IS SUBJECT TO

SETOFF, SO STATE.

CONTINGENT

UNLIQUIDATED

DISPUTED

AMOUNT OF

CLAIM

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

Sheet no.___of___ continuation sheets attached

to Schedule of Creditors Holding Unsecured

Nonpriority Claims

Subtotal
 $

Total


 (Use only on last page of the completed Schedule F.)

 (Report also on Summary of Schedules and, if applicable on the Statistical

Summary of Certain Liabilities and Related Data.)

$

Favela, Ruby

 8243

Capital One Services, LLC

P.O. Box 71083

Charlotte, NC 28272-1083

June, 2009

$2,000.00

** **608-0

Bankruptcy Processing (Macy's)

P.O. Box 8053

Mason, OH 45040

June, 2009

$1347.30

 4-471

Kohl's

P.O. Box 2983

MIlwaukee, WI 53201-2983

June, 2009

$933.42

** **6467

The Children's Place Plan

Processing Center

Des Moines, IA 50364-0001

April, 2009

$210.44

 608-20

Bankruptcy Processing (Macy's)

P.O. Box 8053

Mason, OH 45040

June, 2009

$401.00

2 3 4,892.16

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 29 of 54
B6F (Official Form 6F) (12/07) - Cont. 

In re __________________________________________, Case No. _________________________________

Debtor (if known)

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

(Continuation Sheet)

CREDITOR’S NAME,

 MAILING ADDRESS

 INCLUDING ZIP CODE,

 AND ACCOUNT NUMBER

(See instructions above.)

CODEBTOR

HUSBAND, WIFE,

JOINT, OR

COMMUNITY

DATE CLAIM WAS

INCURRED AND

CONSIDERATION FOR

CLAIM.

 IF CLAIM IS SUBJECT TO

SETOFF, SO STATE.

CONTINGENT

UNLIQUIDATED

DISPUTED

AMOUNT OF

CLAIM

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

Sheet no.___of___ continuation sheets attached

to Schedule of Creditors Holding Unsecured

Nonpriority Claims

Subtotal
 $

Total


 (Use only on last page of the completed Schedule F.)

 (Report also on Summary of Schedules and, if applicable on the Statistical

Summary of Certain Liabilities and Related Data.)

$

Favela, Ruby

Discover Card

P.O. Box 6103

Carol Stream, IL 60197-6103

January, 2009

$7921.30

** **344-0

Baker & Miller, P.C. (Discover)

29 North Wacker Drive

5th Floor

Chicago, IL 60606-2854

January, 2009

$7921.30

3 3 15,842.60

 42,877.86

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 30 of 54
B6G (Official Form 6G) (12/07)

In re , Case No. 

Debtor (if known)

SCHEDULE G - EXECUTORY CONTRACTS AND UNEXPIRED LEASES 

Describe all executory contracts of any nature and all unexpired leases of real or personal property. Include any timeshare

interests. State nature of debtor’s interest in contract, i.e., “Purchaser,” “Agent,” etc. State whether debtor is the lessor or

lessee of a lease. Provide the names and complete mailing addresses of all other parties to each lease or contract described. If

a minor child is a party to one of the leases or contracts, state the child's initials and the name and address of the child's parent

or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and

Fed. R. Bankr. P. 1007(m).

Check this box if debtor has no executory contracts or unexpired leases.

 NAME AND MAILING ADDRESS, 

INCLUDING ZIP CODE,

OF OTHER PARTIES TO LEASE OR CONTRACT.

DESCRIPTION OF CONTRACT OR LEASE AND

NATURE OF DEBTOR’S INTEREST. STATE

WHETHER LEASE IS FOR NONRESIDENTIAL

REAL PROPERTY. STATE CONTRACT

NUMBER OF ANY GOVERNMENT CONTRACT.

Favela, Ruby

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 31 of 54
B6H (Official Form 6H) (12/07)

In re , Case No. 

Debtor (if known)

SCHEDULE H - CODEBTORS

Provide the information requested concerning any person or entity, other than a spouse in a joint case, that is also liable on any debts listed by the

debtor in the schedules of creditors. Include all guarantors and co-signers. If the debtor resides or resided in a community property state,

commonwealth, or territory (including Alaska, Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, or

Wisconsin) within the eight-year period immediately preceding the commencement of the case, identify the name of the debtor’s spouse and of any

former spouse who resides or resided with the debtor in the community property state, commonwealth, or territory. Include all names used by the

nondebtor spouse during the eight years immediately preceding the commencement of this case. If a minor child is a codebtor or a creditor, state the

child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the

child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m).

 Check this box if debtor has no codebtors.

NAME AND ADDRESS OF CODEBTOR NAME AND ADDRESS OF CREDITOR

Favela, Ruby

Juan Favela

1213 Greenvalley Street

Bensenville, IL 60106

Bank of America

Customer Service

P.O. Box 5170

Simi Valley, CA 93062-5170

(1st mortgage related to 1213 Greenvalley Street,

Bensenville, IL 60106 (principal residence))

Juan Favela

1213 Greenvalley Street

Bensenville, IL 60106

Green Tree Bankruptcy Department

P.O. Box 6154

Rapid City, SD 57709

(2nd mortgage related to 1213 Greenvalley Street,

Bensenville, IL 60106 (principal residence))

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 32 of 54
B6I (Official Form 6I) (12/07)

In re , Case No. 

Debtor (if known)

SCHEDULE I - CURRENT INCOME OF INDIVIDUAL DEBTOR(S)

The column labeled “Spouse” must be completed in all cases filed by joint debtors and by every married debtor, whether or not a joint petition is

filed, unless the spouses are separated and a joint petition is not filed. Do not state the name of any minor child. The average monthly income

calculated on this form may differ from the current monthly income calculated on From 22A, 22B, or 22C.

Debtor’s Marital

Status:

DEPENDENTS OF DEBTOR AND SPOUSE

 RELATIONSHIP(S): AGE(S):

Employment: DEBTOR

Occupation

Name of Employer

How long employed

Address of Employer

 SPOUSE

INCOME: (Estimate of average or projected monthly income at time

case filed)

1. Monthly gross wages, salary, and commissions

 (Prorate if not paid monthly)

2. Estimate monthly overtime

3. SUBTOTAL

4. LESS PAYROLL DEDUCTIONS

 a. Payroll taxes and social security

 b. Insurance

 c. Union dues

 d. Other (Specify): 

5. SUBTOTAL OF PAYROLL DEDUCTIONS

6. TOTAL NET MONTHLY TAKE HOME PAY

7. Regular income from operation of business or profession or farm

 (Attach detailed statement)

8. Income from real property

9. Interest and dividends

10. Alimony, maintenance or support payments payable to the debtor for 

 the debtor’s use or that of dependents listed above

11. Social security or government assistance

 (Specify): 

12. Pension or retirement income

13. Other monthly income

 (Specify): 

14. SUBTOTAL OF LINES 7 THROUGH 13

15. AVERAGE MONTHLY INCOME (Add amounts on lines 6 and 14)

16. COMBINED AVERAGE MONTHLY INCOME: (Combine column

totals from line 15) 

DEBTOR SPOUSE

$________________ $______________

$________________ $______________

$_______________ $_____________

$ $ 

$ $

$ $

$ $

$ $

$ $

$ $ 

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

 $

(Report also on Summary of Schedules and, if applicable,

on Statistical Summary of Certain Liabilities and Related Data)

17. Describe any increase or decrease in income reasonably anticipated to occur within the year following the filing of this document:

Favela, Ruby

Married Daughters 3&7

Part-time Legal Secrtary

various attorneys

2 years

Shipping

Averitt, Inc.

2 years

11201 Irving Park Road

Franklin Park, IL 60131

600.00 4796.42

600.00 4796.42

944.73

232.14

1176.87

3619.55

600.00 3619.55

4219.55

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 33 of 54
$______________

B6J (Official Form 6J) (12/07)

In re , Case No. 

Debtor (if known)

SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S)

Complete this schedule by estimating the average or projected monthly expenses of the debtor and the debtor’s family at time case filed. Prorate any payments made biweekly, quarterly, semi-annually, or annually to show monthly rate. The average monthly expenses calculated on this form may differ from the deductions from income

allowed on Form22A or 22C.

Check this box if a joint petition is filed and debtor’s spouse maintains a separate household. Complete a separate schedule of expenditures labeled “Spouse.”

1. Rent or home mortgage payment (include lot rented for mobile home) $ _____________

a. Are real estate taxes included? Yes ________ No ________

b. Is property insurance included? Yes ________ No ________

2. Utilities: a. Electricity and heating fuel $ ______________

b. Water and sewer $ ______________

c. Telephone $ ______________

d. Other ___________________________________________________________________ $ ______________

3. Home maintenance (repairs and upkeep) $ ______________

4. Food $ ______________

5. Clothing $ ______________

6. Laundry and dry cleaning $ ______________

7. Medical and dental expenses $ ______________

8. Transportation (not including car payments) $ ______________

9. Recreation, clubs and entertainment, newspapers, magazines, etc. $ ______________

10.Charitable contributions $ ______________

11.Insurance (not deducted from wages or included in home mortgage payments)

a. Homeowner’s or renter’s $ ______________

b. Life $ ______________

c. Health $ ______________

d. Auto $ ______________

e. Other ___________________________________________________________________ $ ______________

12. Taxes (not deducted from wages or included in home mortgage payments)

(Specify) ___________________________________________________________________________ $ ______________

13. Installment payments: (In chapter 11, 12, and 13 cases, do not list payments to be included in the plan)

a. Auto $ ______________

b. Other ______________________________________________________________ $ ______________

c. Other ____________________________________________________________ $ ______________

14. Alimony, maintenance, and support paid to others $ ______________

15. Payments for support of additional dependents not living at your home $ ______________

16. Regular expenses from operation of business, profession, or farm (attach detailed statement) $ ______________

17. Other __________________________________________________________________________ $______________

18. AVERAGE MONTHLY EXPENSES (Total lines 1-17. Report also on Summary of Schedules and,

 if applicable, on the Statistical Summary of Certain Liabilities and Related Data.)

19. Describe any increase or decrease in expenditures reasonably anticipated to occur within the year following the filing of this document: ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

20. STATEMENT OF MONTHLY NET INCOME

a. Average monthly income from Line 15 of Schedule I $______________

b. Average monthly expenses from Line 18 above $______________

c. Monthly net income (a. minus b.) $______________

Favela, Ruby

2402.68

✔

✔

400.00

100.00

150.00

cable tv/internet 100.00

50.00

400.00

100.00

50.00

300.00

25.00

60.00

4219.55

4102.68

116.87

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 34 of 54
B 201 Page 2

B 201 (04/09/06)

UNITED STATES BANKRUPTCY COURT

NOTICE TO INDIVIDUAL CONSUMER DEBTOR UNDER § 342(b)

OF THE BANKRUPTCY CODE

In accordance with § 342(b) of the Bankruptcy Code, this notice: (1) Describes briefly the services

available from credit counseling services; (2) Describes briefly the purposes, benefits and costs of the four

types of bankruptcy proceedings you may commence; and (3) Informs you about bankruptcy crimes and

notifies you that the Attorney General may examine all information you supply in connection with a

bankruptcy case. You are cautioned that bankruptcy law is complicated and not easily described. Thus,

you may wish to seek the advice of an attorney to learn of your rights and responsibilities should you decide

to file a petition. Court employees cannot give you legal advice. 

1. Services Available from Credit Counseling Agencies

With limited exceptions, § 109(h) of the Bankruptcy Code requires that all individual debtors who file for

bankruptcy relief on or after October 17, 2005, receive a briefing that outlines the available opportunities for credit

counseling and provides assistance in performing a budget analysis. The briefing must be given within 180 days before

the bankruptcy filing. The briefing may be provided individually or in a group (including briefings conducted by telephone

or on the Internet) and must be provided by a nonprofit budget and credit counseling agency approved by the United States

trustee or bankruptcy administrator. The clerk of the bankruptcy court has a list that you may consult of the approved

budget and credit counseling agencies.

In addition, after filing a bankruptcy case, an individual debtor generally must complete a financial

management instructional course before he or she can receive a discharge. The clerk also has a list of approved

financial management instructional courses.

2. The Four Chapters of the Bankruptcy Code Available to Individual Consumer Debtors

Chapter 7: Liquidation ($245 filing fee, $39 administrative fee, $15 trustee surcharge: Total fee $299)

1. Chapter 7 is designed for debtors in financial difficulty who do not have the ability to pay their existing debts. Debtors whose debts are primarily

consumer debts are subject to a “means test” designed to determine whether the case should be permitted to proceed under chapter 7. If your income is

greater than the median income for your state of residence and family size, in some cases, creditors have the right to file a motion requesting that the court

dismiss your case under § 707(b) of the Code. It is up to the court to decide whether the case should be dismissed.

2. Under chapter 7, you may claim certain of your property as exempt under governing law. A trustee may have the right to take possession of and

sell the remaining property that is not exempt and use the sale proceeds to pay your creditors.

3. The purpose of filing a chapter 7 case is to obtain a discharge of your existing debts. If, however, you are found to have committed certain kinds

of improper conduct described in the Bankruptcy Code, the court may deny your discharge and, if it does, the purpose for which you filed the bankruptcy

petition will be defeated.

4. Even if you receive a general discharge, some particular debts are not discharged under the law. Therefore, you may still be responsible for most

taxes and student loans; debts incurred to pay nondischargeable taxes; domestic support and property settlement obligations; most fines, penalties, forfeitures,

and criminal restitution obligations; certain debts which are not properly listed in your bankruptcy papers; and debts for death or personal injury caused by

operating a motor vehicle, vessel, or aircraft while intoxicated from alcohol or drugs. Also, if a creditor can prove that a debt arose from fraud, breach of

fiduciary duty, or theft, or from a willful and malicious injury, the bankruptcy court may determine that the debt is not discharged. 

Chapter 13: Repayment of All or Part of the Debts of an Individual with Regular Income ($235 filing fee,

$39 administrative fee: Total fee $274)

1. Chapter 13 is designed for individuals with regular income who would like to pay all or part of 

their debts in installments over a period of time. You are only eligible for chapter 13 if your debts do not exceed certain dollar amounts set forth in the

Bankruptcy Code.

2. Under chapter 13, you must file with the court a plan to repay your creditors all or part of the money that you owe them, using your future

earnings. The period allowed by the court to repay your debts may be three years or five years, depending upon your income and other factors. The court

must approve your plan before it can take effect.

In re Favela, Ruby

Debtor

Case No.

(If known)

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 35 of 54
B 201 Page 2

3. After completing the payments under your plan, your debts are generally discharged except for domestic support obligations; most student loans;

certain taxes; most criminal fines and restitution obligations; certain debts which are not properly listed in your bankruptcy papers; certain debts for acts that

caused death or personal injury; and certain long term secured obligations.

Chapter 11: Reorganization ($1000 filing fee, $39 administrative fee: Total fee $1039)

Chapter 11 is designed for the reorganization of a business but is also available to consumer debtors. Its provisions are quite complicated, and any

decision by an individual to file a chapter 11 petition should be reviewed with an attorney.

Chapter 12: Family Farmer or Fisherman ($200 filing fee, $39 administrative fee: Total fee $239)

Chapter 12 is designed to permit family farmers and fishermen to repay their debts over a period of time from future earnings and is similar to

chapter 13. The eligibility requirements are restrictive, limiting its use to those whose income arises primarily from a family-owned farm or commercial fishing

operation.

3. Bankruptcy Crimes and Availability of Bankruptcy Papers to Law Enforcement Officials

A person who knowingly and fraudulently conceals assets or makes a false oath or statement under penalty of

perjury, either orally or in writing, in connection with a bankruptcy case is subject to a fine, imprisonment, or both. All

information supplied by a debtor in connection with a bankruptcy case is subject to examination by the Attorney General

acting through the Office of the United States Trustee, the Office of the United States Attorney, and other components and

employees of the Department of Justice.

WARNING: Section 521(a)(1) of the Bankruptcy Code requires that you promptly file detailed information regarding your

creditors, assets, liabilities, income, expenses and general financial condition. Your bankruptcy case may be dismissed if

this information is not filed with the court within the time deadlines set by the Bankruptcy Code, the Bankruptcy Rules, and

the local rules of the court.

Certificate of [Non-Attorney] Bankruptcy Petition Preparer

I, the [non-attorney] bankruptcy petition preparer signing the debtor’s petition, hereby certify that I delivered to the debtor this

notice required by § 342(b) of the Bankruptcy Code.

________________________________________ ___________________________________

Printed name and title, if any, of Bankruptcy Petition Preparer Social Security number (If the bankruptcy petition

preparer is not an individual, state the Social Security 

Address: number of the officer, principal, responsible person, or 

________________________________________ partner of the bankruptcy petition preparer.) (Required

by 11 U.S.C. § 110.)

X_______________________________________

Signature of Bankruptcy Petition Preparer or officer,

principal, responsible person, or partner whose Social

Security number is provided above.

Certificate of the Debtor

I (We), the debtor(s), affirm that I (we) have received and read this notice.

_________________________________________ X___________________________________

Printed Name(s) of Debtor(s) Signature of Debtor Date

Case No. (if known) ____________________ X___________________________________

Signature of Joint Debtor (if any) Date

Address

Ruby Favela /s/ Ruby Favela 01-12-2010

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 36 of 54
B 203

(12/94)

United States Bankruptcy Court

_______________ District Of _______________

In re 

Case No. ___________

Debtor Chapter _________

DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR

 

1. Pursuant to 11 U .S.C. § 329(a) and Fed. Bankr. P. 2016(b), I certify that I am the attorney for the abovenamed debtor(s) and that compensation paid to me w ithin one year before the filing of the petition in

bankruptcy, or agreed to be paid to me, for services rendered or to be rendered on behalf of the debtor(s)

in contemplation of or in connection w ith the bankruptcy case is as follow s:

For legal services, I have agreed to accept ................................... $______________

Prior to the filing of this statement I have received ............................. $______________

Balance D ue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________

2. The source of the compensation paid to me w as:

 D ebtor Other (specify)

3. The source of compensation to be paid to me is:

 D ebtor Other (specify)

4. I have not agreed to share the above-disclosed compensation w ith any other person unless they are

members and associates of my law firm.

I have agreed to share the above-disclosed compensation with a other person or persons w ho are not

members or associates of my law firm. A copy of the agreement, together with a list of the names of

the people sharing in the compensation, is attached.

5. In return for the above-disclosed fee, I have agreed to render legal service for all aspects of the bankruptcy

case, including:

a. Analysis of the debtor' s financial situation, and rendering advice to the debtor in determining whether

to file a petition in bankruptcy;

b. Preparation and filing of any petition, schedules, statements of affairs and plan which may be required;

c. Representati on of the debtor at the meeting of creditors and confirmation hearing, and any adjourned

hearings thereof;

Northern Illinois

Favela, Ruby

7

1,000.00

1,000.00

0.00

✔

✔

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 37 of 54
Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 38 of 54
B7 (Official Form 7) (12/07)

UNITED STATES BANKRUPTCY COURT

______________________________ DISTRICT OF _____________________________

In re:_____ ___________________________________, Case No. ___________________________________

 Debtor (if known)

STATEMENT OF FINANCIAL AFFAIRS

This statement is to be completed by every debtor. Spouses filing a joint petition may file a single statement on which

the information for both spouses is combined. If the case is filed under chapter 12 or chapter 13, a married debtor must furnish

information for both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not

filed. An individual debtor engaged in business as a sole proprietor, partner, family farmer, or self-employed professional,

should provide the information requested on this statement concerning all such activities as well as the individual's personal

affairs. To indicate payments, transfers and the like to minor children, state the child's initials and the name and address of the

child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C.

§112 and Fed. R. Bankr. P. 1007(m).

Questions 1 - 18 are to be completed by all debtors. Debtors that are or have been in business, as defined below, also

must complete Questions 19 - 25. If the answer to an applicable question is "None," mark the box labeled "None." If

additional space is needed for the answer to any question, use and attach a separate sheet properly identified with the case name,

case number (if known), and the number of the question.

DEFINITIONS

"In business." A debtor is "in business" for the purpose of this form if the debtor is a corporation or partnership. An

individual debtor is "in business" for the purpose of this form if the debtor is or has been, within six years immediately preceding

the filing of this bankruptcy case, any of the following: an officer, director, managing executive, or owner of 5 percent or more

of the voting or equity securities of a corporation; a partner, other than a limited partner, of a partnership; a sole proprietor or

self-employed full-time or part-time. An individual debtor also may be “in business” for the purpose of this form if the debtor

engages in a trade, business, or other activity, other than as an employee, to supplement income from the debtor’s primary

employment.

"Insider." The term "insider" includes but is not limited to: relatives of the debtor; general partners of the debtor and

their relatives; corporations of which the debtor is an officer, director, or person in control; officers, directors, and any owner of

5 percent or more of the voting or equity securities of a corporate debtor and their relatives; affiliates of the debtor and insiders

of such affiliates; any managing agent of the debtor. 11 U.S.C. § 101. 

______________________________________________________________________________________________________

1. Income from employment or operation of business

None State the gross amount of income the debtor has received from employment, trade, or profession, or from operation of

the debtor's business, including part-time activities either as an employee or in independent trade or business, from the

beginning of this calendar year to the date this case was commenced. State also the gross amounts received during the

two years immediately preceding this calendar year. (A debtor that maintains, or has maintained, financial records on

the basis of a fiscal rather than a calendar year may report fiscal year income. Identify the beginning and ending dates

of the debtor's fiscal year.) If a joint petition is filed, state income for each spouse separately. (Married debtors filing

under chapter 12 or chapter 13 must state income of both spouses whether or not a joint petition is filed, unless the

spouses are separated and a joint petition is not filed.)

AMOUNT SOURCE 

Northern Illinois

Favela, Ruby

$64,757.04 Legal Secretary & Averitt (January, 2009 through January, 2010)

$60,115.00 Legal Secretary & Averitt (January, 2008 through January, 2009)

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 39 of 54
2

2. Income other than from employment or operation of business

None State the amount of income received by the debtor other than from employment, trade, profession, operation of the

debtor's business during the two years immediately preceding the commencement of this case. Give particulars. If a

joint petition is filed, state income for each spouse separately. (Married debtors filing under chapter 12 or chapter 13

must state income for each spouse whether or not a joint petition is filed, unless the spouses are separated and a joint

petition is not filed.)

AMOUNT SOURCE

_____________________________________________________________________________________________________

3. Payments to creditors

Complete a. or b., as appropriate, and c. None

a. Individual or joint debtor(s) with primarily consumer debts: List all payments on loans, installment purchases of

goods or services, and other debts to any creditor made within 90 days immediately preceding the commencement of

this case unless the aggregate value of all property that constitutes or is affected by such transfer is less than $600.

Indicate with an asterisk (*) any payments that were made to a creditor on account of a domestic support obligation or

as part of an alternative repayment schedule under a plan by an approved nonprofit budgeting and credit counseling

agency. (Married debtors filing under chapter 12 or chapter 13 must include payments by either or both spouses

whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) 

NAME AND ADDRESS OF CREDITOR DATES OF AMOUNT AMOUNT

PAYMENTS PAID STILL OWING

______________________________________________________________________________________________________

None

G b. Debtor whose debts are not primarily consumer debts: List each payment or other transfer to any creditor made

within 90 days immediately preceding the commencement of the case unless the aggregate value of all property that

constitutes or is affected by such transfer is less than $5,475. If the debtor is an individual, indicate with an asterisk (*)

any payments that were made to a creditor on account of a domestic support obligation or as part of an alternative

repayment schedule under a plan by an approved nonprofit budgeting and credit counseling agency. (Married

debtors filing under chapter 12 or chapter 13 must include payments and other transfers by either or both spouses

whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

NAME AND ADDRESS OF CREDITOR DATES OF AMOUNT AMOUNT

PAYMENTS/ PAID OR STILL

TRANSFERS VALUE OF OWING

TRANSFERS

________________________________________________________________________________________________

✔

✔

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 40 of 54
3

None

G c. All debtors: List all payments made within one year immediately preceding the commencement of this case

 to or for the benefit of creditors who are or were insiders. (Married debtors filing under chapter 12 or chapter 13 must

include payments by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and

a joint petition is not filed.)

NAME AND ADDRESS OF CREDITOR DATE OF AMOUNT AMOUNT

AND RELATIONSHIP TO DEBTOR PAYMENT PAID STILL OWING

______________________________________________________________________________________________________

4. Suits and administrative proceedings, executions, garnishments and attachments

None a. List all suits and administrative proceedings to which the debtor is or was a party within one year immediately

preceding the filing of this bankruptcy case. (Married debtors filing under chapter 12 or chapter 13 must include

information concerning either or both spouses whether or not a joint petition is filed, unless the spouses are separated

and a joint petition is not filed.)

CAPTION OF SUIT COURT OR AGENCY STATUS OR

AND CASE NUMBER NATURE OF PROCEEDING AND LOCATION DISPOSITION

______________________________________________________________________________________________________

None b. Describe all property that has been attached, garnished or seized under any legal or equitable process within one

year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13

must include information concerning property of either or both spouses whether or not a joint petition is filed, unless

the spouses are separated and a joint petition is not filed.)

NAME AND ADDRESS DESCRIPTION 

OF PERSON FOR WHOSE DATE OF AND VALUE

BENEFIT PROPERTY WAS SEIZED SEIZURE OF PROPERTY

_____________________________________________________________________________________________________

5. Repossessions, foreclosures and returns

None List all property that has been repossessed by a creditor, sold at a foreclosure sale, transferred through a deed in lieu 

of foreclosure or returned to the seller, within one year immediately preceding the commencement of this case. 

(Married debtors filing under chapter 12 or chapter 13 must include information concerning property of either or both

spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

DATE OF REPOSSESSION, DESCRIPTION

NAME AND ADDRESS FORECLOSURE SALE, AND VALUE

 OF CREDITOR OR SELLER TRANSFER OR RETURN OF PROPERTY

_

______________________________________________________________________________________________________

✔

✔

✔

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 41 of 54
4

6. Assignments and receiverships

None a. Describe any assignment of property for the benefit of creditors made within 120 days immediately preceding the

commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include any assignment by

either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not

filed.)

TERMS OF

NAME AND ADDRESS DATE OF ASSIGNMENT

OF ASSIGNEE ASSIGNMENT OR SETTLEMENT

________________________________________________________________________________________________

None b. List all property which has been in the hands of a custodian, receiver, or court-appointed official within one year

immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must

include information concerning property of either or both spouses whether or not a joint petition is filed, unless the

spouses are separated and a joint petition is not filed.)

 NAME AND LOCATION DESCRIPTION

NAME AND ADDRESS OF COURT DATE OF AND VALUE

OF CUSTODIAN CASE TITLE & NUMBER ORDER Of PROPERTY

______________________________________________________________________________________________________

7. Gifts 

None List all gifts or charitable contributions made within one year immediately preceding the commencement of this case

except ordinary and usual gifts to family members aggregating less than $200 in value per individual family member

and charitable contributions aggregating less than $100 per recipient. (Married debtors filing under chapter 12 or

chapter 13 must include gifts or contributions by either or both spouses whether or not a joint petition is filed, unless

the spouses are separated and a joint petition is not filed.)

NAME AND ADDRESS RELATIONSHIP DESCRIPTION

OF PERSON TO DEBTOR, DATE AND VALUE

OR ORGANIZATION IF ANY OF GIFT OF GIFT

_____________________________________________________________________________________________________

8. Losses

None List all losses from fire, theft, other casualty or gambling within one year immediately preceding the commencement

of this case or since the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must

include losses by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a

joint petition is not filed.)

DESCRIPTION DESCRIPTION OF CIRCUMSTANCES AND, IF

AND VALUE OF LOSS WAS COVERED IN WHOLE OR IN PART DATE

PROPERTY BY INSURANCE, GIVE PARTICULARS OF LOSS

______________________________________________________________________________________________________

✔

✔

✔

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 42 of 54
5

9. Payments related to debt counseling or bankruptcy

None List all payments made or property transferred by or on behalf of the debtor to any persons, including attorneys, for 

consultation concerning debt consolidation, relief under the bankruptcy law or preparation of a petition in bankruptcy

within one year immediately preceding the commencement of this case.

DATE OF PAYMENT, AMOUNT OF MONEY OR

NAME AND ADDRESS NAME OF PAYER IF DESCRIPTION AND

OF PAYEE OTHER THAN DEBTOR VALUE OF PROPERTY

______________________________________________________________________________________________________

10. Other transfers None

 a. List all other property, other than property transferred in the ordinary course of the business or financial affairs of

the debtor, transferred either absolutely or as security within two years immediately preceding the commencement of

this case. (Married debtors filing under chapter 12 or chapter 13 must include transfers by either or both spouses

whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

NAME AND ADDRESS OF TRANSFEREE, DESCRIBE PROPERTY

RELATIONSHIP TO DEBTOR TRANSFERRED AND 

DATE VALUE RECEIVED

______________________________________________________________________________________________________

None

G b. List all property transferred by the debtor within ten years immediately preceding the commencement of this case

to a self-settled trust or similar device of which the debtor is a beneficiary.

NAME OF TRUST OR OTHER DATE(S) OF AMOUNT OF MONEY OR DESCRIPTION

DEVICE TRANSFER(S) AND VALUE OF PROPERTY OR DEBTOR’S

INTEREST IN PROPERTY

______________________________________________________________________________________________________

11. Closed financial accounts 

None List all financial accounts and instruments held in the name of the debtor or for the benefit of the debtor which were

closed, sold, or otherwise transferred within one year immediately preceding the commencement of this case. Include

checking, savings, or other financial accounts, certificates of deposit, or other instruments; shares and share accounts

held in banks, credit unions, pension funds, cooperatives, associations, brokerage houses and other financial

institutions. (Married debtors filing under chapter 12 or chapter 13 must include information concerning accounts or

instruments held by or for either or both spouses whether or not a joint petition is filed, unless the spouses are

separated and a joint petition is not filed.)

TYPE OF ACCOUNT, LAST FOUR AMOUNT AND

NAME AND ADDRESS DIGITS OF ACCOUNT NUMBER, DATE OF SALE 

OF INSTITUTION AND AMOUNT OF FINAL BALANCE OR CLOSING 

______________________________________________________________________________________________________

Money Management International, Inc.

John Haderlein, ESQ.

815-C Country Club Drive

Libertyville, IL 60048

January, 2010

January, 2010

$50.00

$1,000.00

✔

✔

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 43 of 54
6

12. Safe deposit boxes

None List each safe deposit or other box or depository in which the debtor has or had securities, cash, or other valuables

within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or

chapter 13 must include boxes or depositories of either or both spouses whether or not a joint petition is filed, unless

the spouses are separated and a joint petition is not filed.)

NAME AND ADDRESS NAMES AND ADDRESSES DESCRIPTION DATE OF TRANSFER

OF BANK OR OF THOSE WITH ACCESS OF OR SURRENDER,

OTHER DEPOSITORY TO BOX OR DEPOSITORY CONTENTS IF ANY

_

______________________________________________________________________________________________________

13. Setoffs

None List all setoffs made by any creditor, including a bank, against a debt or deposit of the debtor within 90 days preceding

the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information

concerning either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint

petition is not filed.)

DATE OF AMOUNT

NAME AND ADDRESS OF CREDITOR SETOFF OF SETOFF

_____________________________________________________________________________________________________

14. Property held for another person

None List all property owned by another person that the debtor holds or controls.

NAME AND ADDRESS DESCRIPTION AND

OF OWNER VALUE OF PROPERTY LOCATION OF PROPERTY

_____________________________________________________________________________________________________

15. Prior address of debtor

None

G If debtor has moved within three years immediately preceding the commencement of this case, list all premises 

which the debtor occupied during that period and vacated prior to the commencement of this case. If a joint petition is

filed, report also any separate address of either spouse.

ADDRESS NAME USED DATES OF OCCUPANCY

_____________________________________________________________________________

✔

✔

✔

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 44 of 54
7

16. Spouses and Former Spouses

None If the debtor resides or resided in a community property state, commonwealth, or territory (including Alaska, Arizona,

 California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, or Wisconsin) within eight

years immediately preceding the commencement of the case, identify the name of the debtor’s spouse and of 

any former spouse who resides or resided with the debtor in the community property state. 

NAME

______________________________________________________________________________________________________

17. Environmental Information.

For the purpose of this question, the following definitions apply:

 "Environmental Law" means any federal, state, or local statute or regulation regulating pollution, contamination,

releases of hazardous or toxic substances, wastes or material into the air, land, soil, surface water, groundwater, or

other medium, including, but not limited to, statutes or regulations regulating the cleanup of these substances, wastes,

or material.

"Site" means any location, facility, or property as defined under any Environmental Law, whether or not presently or

formerly owned or operated by the debtor, including, but not limited to, disposal sites. 

"Hazardous Material" means anything defined as a hazardous waste, hazardous substance, toxic substance, hazardous

material, pollutant, or contaminant or similar term under an Environmental Law.

________________________________________________________________________________________________

None a. List the name and address of every site for which the debtor has received notice in writing by a governmental

unit that it may be liable or potentially liable under or in violation of an Environmental Law. Indicate the

governmental unit, the date of the notice, and, if known, the Environmental Law:

SITE NAME NAME AND ADDRESS DATE OF ENVIRONMENTAL

AND ADDRESS OF GOVERNMENTAL UNIT NOTICE LAW

______________________________________________________________________________________________________

None b. List the name and address of every site for which the debtor provided notice to a governmental unit of a release

 of Hazardous Material. Indicate the governmental unit to which the notice was sent and the date of the notice.

SITE NAME NAME AND ADDRESS DATE OF ENVIRONMENTAL

AND ADDRESS OF GOVERNMENTAL UNIT NOTICE LAW

_____________________________________________________________________________________________________

None c. List all judicial or administrative proceedings, including settlements or orders, under any Environmental Law with

respect to which the debtor is or was a party. Indicate the name and address of the governmental unit that is or was a party

to the proceeding, and the docket number.

NAME AND ADDRESS DOCKET NUMBER STATUS OR 

OF GOVERNMENTAL UNIT DISPOSITION

______________________________________________________________________________________________________

18 . Nature, location and name of business

None a. If the debtor is an individual, list the names, addresses, taxpayer-identification numbers, nature of the businesses,

and beginning and ending dates of all businesses in which the debtor was an officer, director, partner, or managing

executive of a corporation, partner in a partnership, sole proprietor, or was self-employed in a trade, profession, or

other activity either full- or part-time within six years immediately preceding the commencement of this case, or in

✔

✔

✔

✔

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 45 of 54
8

which the debtor owned 5 percent or more of the voting or equity securities within six years immediately preceding

the commencement of this case.

If the debtor is a partnership, list the names, addresses, taxpayer-identification numbers, nature of the businesses,

and beginning and ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of

the voting or equity securities, within six years immediately preceding the commencement of this case.

If the debtor is a corporation, list the names, addresses, taxpayer-identification numbers, nature of the businesses,

and beginning and ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of

the voting or equity securities within six years immediately preceding the commencement of this case.

LAST FOUR DIGITS

OF SOCIAL-SECURITY BEGINNING AND 

NAME OR OTHER INDIVIDUAL ADDRESS NATURE OF BUSINESS ENDING DATES

TAXPAYER-I.D. NO.

(ITIN)/ COMPLETE EIN

______________________________________________________________________________________________________

None b. Identify any business listed in response to subdivision a., above, that is "single asset real estate" as

defined in 11 U.S.C. § 101.

NAME ADDRESS

______________________________________________________________________________________________________

The following questions are to be completed by every debtor that is a corporation or partnership and by any individual

debtor who is or has been, within six years immediately preceding the commencement of this case, any of the following: an

officer, director, managing executive, or owner of more than 5 percent of the voting or equity securities of a corporation; a

partner, other than a limited partner, of a partnership, a sole proprietor, or self-employed in a trade, profession, or other activity,

either full- or part-time.

(An individual or joint debtor should complete this portion of the statement only if the debtor is or has been in

business, as defined above, within six years immediately preceding the commencement of this case. A debtor who has not been

in business within those six years should go directly to the signature page.)

_____________________________________________________________________________________________________

19. Books, records and financial statements

None a. List all bookkeepers and accountants who within two years immediately preceding the filing of this

bankruptcy case kept or supervised the keeping of books of account and records of the debtor.

NAME AND ADDRESS DATES SERVICES RENDERED

________________________________________________________________________________________________

None b. List all firms or individuals who within two years immediately preceding the filing of this bankruptcy

case have audited the books of account and records, or prepared a financial statement of the debtor.

NAME ADDRESS DATES SERVICES RENDERED

_____________________________________________________________________________________________________

✔

✔

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 46 of 54
9

None c. List all firms or individuals who at the time of the commencement of this case were in possession of the 

books of account and records of the debtor. If any of the books of account and records are not available, explain.

NAME ADDRESS

________________________________________________________________________________________________

None d. List all financial institutions, creditors and other parties, including mercantile and trade agencies, to whom a

financial statement was issued by the debtor within two years immediately preceding the commencement of this case.

NAME AND ADDRESS DATE ISSUED

________________________________________________________________________________________________

20. Inventories

None a. List the dates of the last two inventories taken of your property, the name of the person who supervised the

taking of each inventory, and the dollar amount and basis of each inventory.

 DOLLAR AMOUNT

OF INVENTORY

DATE OF INVENTORY INVENTORY SUPERVISOR (Specify cost, market or other

basis)

____________________________________________________________________________________________________

None b. List the name and address of the person having possession of the records of each of the inventories reported

in a., above. 

NAME AND ADDRESSES

OF CUSTODIAN

DATE OF INVENTORY OF INVENTORY RECORDS

____________________________________________________________________________________________________

21 . Current Partners, Officers, Directors and Shareholders

None a. If the debtor is a partnership, list the nature and percentage of partnership interest of each member of the 

partnership.

NAME AND ADDRESS NATURE OF INTEREST PERCENTAGE OF INTEREST

______________________________________________________________________________________________________

None b. If the debtor is a corporation, list all officers and directors of the corporation, and each stockholder who 

directly or indirectly owns, controls, or holds 5 percent or more of the voting or equity securities of the 

corporation.

NATURE AND PERCENTAGE 

NAME AND ADDRESS TITLE OF STOCK OWNERSHIP

__________________________________________________________________________________________________

✔

✔

✔

✔

✔

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 47 of 54
10

22 . Former partners, officers, directors and shareholders

None a. If the debtor is a partnership, list each member who withdrew from the partnership within one year immediately

preceding the commencement of this case.

NAME ADDRESS DATE OF WITHDRAWAL

___________________________________________________________________________________________________

None b. If the debtor is a corporation, list all officers or directors whose relationship with the corporation terminated 

within one year immediately preceding the commencement of this case.

NAME AND ADDRESS TITLE DATE OF TERMINATION

___________________________________________________________________________________________________

23 . Withdrawals from a partnership or distributions by a corporation

None If the debtor is a partnership or corporation, list all withdrawals or distributions credited or given to an insider,

including compensation in any form, bonuses, loans, stock redemptions, options exercised and any other perquisite

during one year immediately preceding the commencement of this case.

NAME & ADDRESS AMOUNT OF MONEY 

OF RECIPIENT, DATE AND PURPOSE OR DESCRIPTION

RELATIONSHIP TO DEBTOR OF WITHDRAWAL AND VALUE OF PROPERTY

___________________________________________________________________

24. Tax Consolidation Group. 

None If the debtor is a corporation, list the name and federal taxpayer-identification number of the parent corporation of any

consolidated group for tax purposes of which the debtor has been a member at any time within six years

immediately preceding the commencement of the case. 

NAME OF PARENT CORPORATION TAXPAYER-IDENTIFICATION NUMBER (EIN)

_____________________________________________________________________________________________________

25. Pension Funds. 

None If the debtor is not an individual, list the name and federal taxpayer-identification number of any pension fund to

 which the debtor, as an employer, has been responsible for contributing at any time within six years immediately

preceding the commencement of the case.

NAME OF PENSION FUND TAXPAYER-IDENTIFICATION NUMBER (EIN)

* * * * * *

✔

✔

✔

✔

✔

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 48 of 54
11

[If completed by an individual or individual and spouse]

I declare under penalty of perjury that I have read the answers contained in the foregoing statement of financial

affairs and any attachments thereto and that they are true and correct.

Date __________________________ Signature

_____________________________________________

of Debtor

Date __________________________ Signature_________________________________________ 

of Joint Debtor

(if any)

__________________________________________________________________________________________________________________________

[If completed on behalf of a partnership or corporation]

I declare under penalty of perjury that I have read the answers contained in the foregoing statement of financial affairs and any attachments

thereto and that they are true and correct to the best of my knowledge, information and belief.

Date __________________________ Signature

__________________________________________________

_________________________________________________

Print Name and Title

[An individual signing on behalf of a partnership or corporation must indicate position or relationship to debtor.]

____ continuation sheets attached

Penalty for making a false statement: Fine of up to $500,000 or imprisonment for up to 5 years, or both. 18 U.S.C. §§ 152 and 3571

___________________________________________________________________________________________________

DECLARATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110)

 I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110; (2) I prepared this document for

compensation and have provided the debtor with a copy of this document and the notices and information required under 11 U.S.C. §§ 110(b), 110(h),

and 342(b); and, (3) if rules or guidelines have been promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum fee for services chargeable by

bankruptcy petition preparers, I have given the debtor notice of the maximum amount before preparing any document for filing for a debtor or accepting

any fee from the debtor, as required by that section.

_____________________________________________________ _____________________________

Printed or Typed Name and Title, if any, of Bankruptcy Petition Preparer Social-Security No. (Required by 11 U.S.C. § 110.)

If the bankruptcy petition preparer is not an individual, state the name, title (if any), address, and social-security number of the officer, principal,

responsible person, or partner who signs this document.

________________________________

_________________________________

Address

X _____________________________________________________ ____________________

 Signature of Bankruptcy Petition Preparer Date

Names and Social-Security numbers of all other individuals who prepared or assisted in preparing this document unless the bankruptcy petition preparer is

not an individual:

If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person

A bankruptcy petition preparer's failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in

fines or imprisonment or both. 18 U.S.C. § 156.

01-12-2010 /s/ Ruby Favela

Print Name and Title

Address

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 49 of 54
Form 8

(10/05)

United States Bankruptcy Court

_______________ District Of _______________

In re ____________________________,

Debtor Case No. ___________________

Chapter 7

CHAPTER 7 INDIVIDUAL DEBTOR'S STATEMENT OF INTENTION

 I have filed a schedule of assets and liabilities which includes debts secured by property of the estate.

 I have filed a schedule of executory contracts and unexpired leases which includes personal property subject to an unexpired lease.

 I intend to do the following with respect to the property of the estate which secures those debts or is subject to a lease:

Description of Secured 

Property

Creditor’s

Name

Property will be

Surrendered

Property

is claimed

as exempt

Property will

be redeemed

pursuant to

11 U.S.C. § 722

Debt will be

reaffirmed

pursuant to

11 U.S.C. § 524(c)

Description of Leased 

Property

Lessor’s

Name

Lease will be

assumed pursuant

to 11 U.S.C.

§ 362(h)(1)(A)

Date: ____________________ ___________________________________________

Signature of Debtor

---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

DECLARATION OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110)

 I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110; (2) I prepared this document for

compensation and have provided the debtor with a copy of this document and the notices and information required under 11 U.S.C. §§ 110(b),

110(h), and 342(b); and, (3) if rules or guidelines have been promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum fee for services

chargeable by bankruptcy petition preparers, I have given the debtor notice of the maximum amount before preparing any document for filing for a

debtor or accepting any fee from the debtor, as required in that section.

___________________________________________________ ________________________

Printed or Typed Name of Bankruptcy Petition Preparer Social Security No. (Required under 11 U.S.C. § 110.)

If the bankruptcy petition preparer is not an individual, state the name, title (if any), address, and social security number of the officer, principal,

responsible person or partner who signs this document. 

____________________________________________

_______________________________________

Address

X__________________________________________ _________________

 Signature of Bankruptcy Petition Preparer Date

Names and Social Security Numbers of all other individuals who prepared or assisted in preparing this document unless the bankruptcy petition

preparer is not an individual:

If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person.

A bankruptcy petition preparer’s failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fines

or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156.

Northern Illinois

Favela, Ruby

✔

✔

1213 Greenvalley Street,

Bensenville, IL 60106

(principal residence)

Bank of

America &

Greentree (2

mortgages)

No Yes Yes Yes

01-10-2010 /s/ Ruby Favela

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 50 of 54
1

UNITED STATES BANKRUPTCY COURT 

NORTHERN DISTRICT OF ILLINOIS 

IN RE: ) 

 ) 

RUBY FAVELA, DEBTOR ) No. 

 ) Chapter 7 

 ) 

 

VERIFICATION OF CREDITOR MATRIX

 Number of Creditors: 20 

The above-named Debtor(s) hereby verifies that the list of creditors is true and correct 

to the best of my knowledge. 

Date: January 12, 2010 /s/ Ruby Favela 

 .............................. 

 Debtor 

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 51 of 54
Ruby Favela 

1213 Greenvalley Street 

Bensenville, IL 60106 

Law Offices of John Haderlein, Esq. 

815-C Country Club Drive 

Libertyville, IL 60048 

Bank of America 

Customer Service 

P.O. Box 5170 

Simi Valley, CA 93062-5170 

Green Tree Bankruptcy Department 

P.O. Box 6154 

Rapid City, SD 57709 

NCO Financial Systems, Inc. 

P.O. Box 15630 

Dept. 02 

Wilmington, DE 19850 

NCO Financial Systems, Inc. 

P.O. Box 15630 

Dept. 72 

Wilmington, DE 19850 

Victoria's Secret 

13526 Nacogdoches Road 

San Antonio, TX 78217-1274 

GE Money Bank (JC Penney) 

Attn: Bankruptcy Department 

P.O. Box 103104 

Roswell, GA 30076 

Weltman, Weisberg & Reis (PNC) 

323 W. Lakeside, Suite 200 

Cleveland, OH 44113-1009 

Premier Credit Corp (Rogers & Holland) 

4245 Brockton Drive 

Suite B 

Kentwood, MU 49512 

Rogers Enterprise (Rogers & Holland) 

P.O. Box 879 

Matteson, IL 60443 

First Source (Target National Bank) 

205 Bryant Woods South 

Amherst, NY 14228 

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 52 of 54
HSBC Card Services 

P.O. Box 60102 

City of Industry, CA 91716-0102 

Capital One Services, LLC 

P.O. Box 71083 

Charlotte, NC 28272-1083 

Bankruptcy Processing (Macy's) 

P.O. Box 8053 

Mason, OH 45040 

Kohl's 

P.O. Box 2983 

MIlwaukee, WI 53201-2983 

The Children's Place Plan 

Processing Center 

Des Moines, IA 50364-0001 

Bankruptcy Processing (Macy's) 

P.O. Box 8053 

Mason, OH 45040 

Discover Card 

P.O. Box 6103 

Carol Stream, IL 60197-6103 

Baker & Miller, P.C. (Discover) 

29 North Wacker Drive 

5th Floor 

Chicago, IL 60606-2854 

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 53 of 54
B6 Declaration (Official Form 6 - Declaration) (12/07)

In re _________________________________________ , Case No. ______________________________

Debtor (if known)

DECLARATION CONCERNING DEBTOR'S SCHEDULES

DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR

I declare under penalty of perjury that I have read the foregoing summary and schedules, consisting of _____ sheets, and that they are true and correct to the best of

my knowledge, information, and belief.

Date __________________________________ Signature: ________________________________________________

Debtor

Date __________________________________ Signature: ________________________________________________

(Joint Debtor, if any)

[If joint case, both spouses must sign.]

 -------------------------------------------------------------------------------------------------------------------------------------------

DECLARATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110)

 I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110; (2) I prepared this document for compensation and have provided

the debtor with a copy of this document and the notices and information required under 11 U.S.C. §§ 110(b), 110(h) and 342(b); and, (3) if rules or guidelines have been

promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum fee for services chargeable by bankruptcy petition preparers, I have given the debtor notice of the maximum

amount before preparing any document for filing for a debtor or accepting any fee from the debtor, as required by that section.

_____________________________________________________ _____________________________

Printed or Typed Name and Title, if any, Social Security No.

of Bankruptcy Petition Preparer (Required by 11 U.S.C. § 110.)

If the bankruptcy petition preparer is not an individual, state the name, title (if any), address, and social security number of the officer, principal, responsible person, or partner

who signs this document.

_________________________________

_________________________________

_________________________________

Address

X _____________________________________________________ ____________________

 Signature of Bankruptcy Petition Preparer Date

Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document, unless the bankruptcy petition preparer is not an individual:

If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person.

A bankruptcy petition preparer's failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or both. 11 U.S.C. § 110;

18 U.S.C. § 156.

 --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

DECLARATION UNDER PENALTY OF PERJURY ON BEHALF OF A CORPORATION OR PARTNERSHIP

I, the __________________________________ [the president or other officer or an authorized agent of the corporation or a member or an authorized agent of the

partnership ] of the ___________________________________ [corporation or partnership] named as debtor in this case, declare under penalty of perjury that I have

read the foregoing summary and schedules, consisting of ___ sheets (Total shown on summary page plus 1), and that they are true and correct to the best of my

knowledge, information, and belief.

Date ______________________________________

Signature: _____________________________________________________________

 ____________________________________________________________

[Print or type name of individual signing on behalf of debtor.]

[An individual signing on behalf of a partnership or corporation must indicate position or relationship to debtor.]

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Penalty for making a false statement or concealing property: Fine of up to $500,000 or imprisonment for up to 5 years or both. 18 U.S.C. §§ 152 and 3571. 

Favela, Ruby

18

01-12-2010 /s/ Ruby Favela

Address

Case 10-00882 Doc 1 Filed 01/12/10 Entered 01/12/10 10:21:58 Desc Main

 Document Page 54 of 54